Disseminated Zoster Involving the Whole Body in an Immunocompetent Patient Complaining of Left Leg Radiating Pain and Weakness: A Case Report and Literature Review

Abstract

Introduction Disseminated herpes zoster is defined as at least 20 skin lesions in multiple dermatomes. In particular, it has been reported mainly in patients with immunological defects. To our knowledge, there is no reported case of disseminated zoster in a non-immunocompromised patient with leg radiating pain and weakness. Case presentation A 74-year-old man visited our hospital with left leg radiating pain and left hip pain. He had no underlying disease other than hypertension. Neurologic examination revealed radiating pain on the L4 dermatome of the left leg. The muscle power was grade 3 for the hip flexor and knee extensor, and grade 4 for the ankle dorsiflexor and big toe dorsiflexor of the left leg. There were no sensory changes or skin lesions on his left leg. Herniation of the nucleus pulposus of the lumbar spine was suspected and lumbar magnetic resonance imaging (MRI) was performed. However, no pathologic lesions were seen on lumbar MRI. On the third day of hospitalization, erythematous patches and vesicles were observed on the head, face, ear, neck, trunk, back, and both lower extremities. Herpes zoster infection was confirmed by polymerase chain reaction analysis. Treatment was performed with 250 mg of intravenous acyclovir every 8 hours for 6 days and 62.5 mg of intravenous methylprednisolone for 4 days. On the 13th day of hospitalization, the skin lesions and left leg radiating pain and weakness improved. Conclusion We report the first case of disseminated herpes zoster involving the whole body in a non-immunocompromised patient complaining of left leg radiating pain and weakness. After treatment, both the patient’s radiating pain and weakness improved.

Multidermatomal herpes zoster triggered by psychological stress in an immunocompetent young adult: a rare case report and clinical insights

“…Individuals with multidermatomal involvement may present with skin rashes, itching, painful vesicular eruptions, headache, and fever and with several remarkable clinical spectrums, timely identification, and early management of which put a significant impact on their physical and mental health. Furthermore, the atypical presentation of multidermatomal HZV deviating from its conventional pattern poses a clinical dilemma in clinical management 14 . As described in our case the patient had no other symptoms as explained above except the painful vesicular skin lesions over multiple dermatomes and the history of perceived psychological stress.…”

Disseminated herpes zoster in an Immunocompetent patient on long-term Clozapine: case report

“…A recent case review from 2022 detailed 22 prior case reports of disseminated herpes zoster. 12 Since that analysis in 2022 one additional patient has been reported. 13 A study looking at hospital visits by patients in Canada prior to 2016 found 2 immunocompetent patients per million had disseminated zoster.…”

Current challenges in diagnosing and treating infectious skin diseases – a case series

“…upośledzenie wzroku i słuchu oraz dolegliwości neurologiczne spowodowane uszkodzeniem naczyń mózgowych, zapaleniem rdzenia kręgowego, porażeniem nerwów czaszkowych i obwodowych oraz zapaleniem wielokorzeniowym (15). DZ definiowany jest jako obecność co najmniej 20 zmian poza obszarem zajętego i sąsiadującego dermatomu i może dotykać nawet 2% populacji ogólnej oraz 15-30% populacji chorych w stanie immunosupresji (19). Nasilenie bólu oraz objawy systemowe sugerują-chickenpox develops, after which the virus enters a latent form in the neurons of the cranial nerves, spinal ganglia, or autonomic system ganglia.…”

“…Other serious complications include impaired vision and hearing and neurological complaints caused by damage to cerebral vessels, spinal cord inflammation, paralysis of cranial and peripheral nerves, and polyradiculitis (15). Disseminated zoster (DZ) is defined as the presence of at least 20 lesions outside the affected and adjacent dermatome and can affect even 2% of the general population and 15-30% of the immunosuppressed patient population (19). The intensity of pain and systemic symptoms suggesting VZV viremia are typical for severe cases of shingles, which increase the risk of complications such as inflammation of the heart, liver, or brain, and secondary bacterial infection.…”