Cervical Radiculopathy Associated With Shingles Herpes Zoster Infection

Segmental zoster paresis (SZP) of the limbs, characterized by focal weakness of the extremity, is recognized as a rare complication of herpes zoster that can lead to a misdiagnosis of other radiculopathies or musculoskeletal problems. Here, we present a rare case where the patient experienced severe pain and weakness of the right upper extremity caused by SZP. A 58-year-old man came to the hospital with severe right upper extremity radicular pain. Cervical magnetic resonance imaging of the spinal cord showed disc protrusion at the C5-6 level with a high signal change. Anterior cervical discectomy and fusion was performed. On the first and second postoperative days, the patient’s symptoms showed slight improvements. However, on the fourth postoperative day, the patient experienced a right shoulder drop along with exacerbated radicular pain and presented a herpetic rash on the right extremity. The patient showed a dramatic improvement in pain and weakness after taking antiviral medication and undergoing a fluoroscopic-guided right C6 selective nerve root block. He fully recovered from his symptoms after 12 weeks of rehabilitation and physical therapy. This rare case involved SZP which was misunderstood as a herniated cervical disc. If a patient complains of severe pain with motor weakness inconsistent with radiologic findings, SZP should be discriminated from other possible diagnosis.

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“…The patient in our case also experienced neuralgia followed by skin lesions occurring one week later. This led to our misdiagnosis 6) .…”

Section: Discussionmentioning

confidence: 98%

“…Skin lesions generally precede the neurologic symptoms by several days to one week. Some studies reported that in some rare incidents, neurologic symptoms occurred before skin lesions [1][2][3][6][7][8] . The patient in our case also experienced neuralgia followed by skin lesions occurring one week later.…”

Section: Discussionmentioning

confidence: 99%

Segmental Zoster Paresis with Late-Onset Skin Rash Mimicking a Herniated Cervical Disc: A Case Report

Jeong

Kim

2022

Nerve

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“…Our report discusses a patient with zoster radiculopathy and cervical radiculopathy in the same segment. Although they may be separate pathologies, an association may exist and warrant further clinical discussion and evaluation 6. Kang et al described a patient with herpes zoster and cervical spinal stenosis at the same spinal level 7.…”

Section: Discussionmentioning

confidence: 99%

“…Kang et al described a patient with herpes zoster and cervical spinal stenosis at the same spinal level 7. Miller et al also described a patient with zoster radiculopathy with concurrent C5–C6 cervical spine radiculopathy occurring a week following his influenza and pneumococcal vaccination 6…”

Section: Discussionmentioning

confidence: 99%

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Acute herpes zoster radiculopathy mimicking cervical radiculopathy after ChAdOx1 nCoV-19/AZD1222 vaccination

et al. 2022

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This case report describes an 84-year-old man who presented with 3 weeks of gradually worsening right arm weakness associated with a painful vesicular rash across his arm. This occurred 3 days after his first dose of the ChAdOx1 nCoV-19/AZD1222 (University of Oxford, AstraZeneca and the Serum Institute of India) vaccine. The diagnosis was complicated by the presence of right C5–C6 foraminal stenosis compressing on the C6 nerve root sheath on non-contrast MRI, leading to an initial diagnosis of cervical radiculopathy. However, a positive varicella zoster virus-PCR test and findings of abnormal contrast enhancement of his right C5–C7 nerve roots on gadolinium-enhanced MRI resulted in a revision of his diagnosis to zoster radiculopathy. He was subsequently commenced on oral valacilovir and made significant recovery. This report aims to highlight the diagnostic dilemma between cervical radiculopathy secondary to spondylosis and zoster radiculopathy and how an erroneous diagnosis could result in inappropriate, aggressive surgical intervention and delayed treatment with antiviral therapy.

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Cervical Radiculopathy Associated With Shingles Herpes Zoster Infection

Cited by 2 publications

References 7 publications

Segmental Zoster Paresis with Late-Onset Skin Rash Mimicking a Herniated Cervical Disc: A Case Report

Segmental Zoster Paresis with Late-Onset Skin Rash Mimicking a Herniated Cervical Disc: A Case Report

Acute herpes zoster radiculopathy mimicking cervical radiculopathy after ChAdOx1 nCoV-19/AZD1222 vaccination

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