HSV-2 sacral radiculitis (Elsberg syndrome)

Eberhardt, Oliver; Küker, Wilhelm; Dichgans, J.; Weller, Michael

doi:10.1212/01.wnl.0000134652.51657.10

Cited by 88 publications

(108 citation statements)

References 6 publications

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“…Human HSV-2 has been described to be a common etiology of Elsberg syndrome, whereas other herpesviruses, such as HSV-1, VZV, EpsteinBarr virus and cytomegalovirus, have been reported to be associated with lumbosacral radiculomyelitis (6,8). Lumbosacral radiculomyelitis is commonly detected on spinal MRI imaging, which shows varying degrees of root or lower spinal cord edema with enlargement and hyperintensity on T 2-weighted images, although there may be no spinal abnormalities in some cases (8). In the current case, spinal MRI did not show any abnormalities; however, we diagnosed the patient with Elsberg syndrome based on his clinical course.…”

Section: Discussionmentioning

confidence: 99%

“…Other herpesviruses, including VZV, cytomegalovirus and Epstein-Barr virus, have also been shown to be associated with Elsberg syndrome, although there are few reports of cases of Elsberg syndrome (6)(7)(8). In addition, the onset of VZV meningitis associated with Elsberg syndrome has been previously reported, whereas no cases of VZV infection without a skin rash associated with Elsberg syndrome have been documented.…”

Section: Introductionmentioning

confidence: 99%

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Varicella Zoster Virus Meningoencephalitis Presenting with Elsberg Syndrome without a Rash in an Immunocompetent Patient

et al. 2015

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Varicella zoster virus (VZV) infection usually manifests with a skin rash. To the best of our knowledge, this is the first report of a case of VZV meningoencephalitis presenting with Elsberg syndrome without a rash in an immunocompetent patient. Clinicians should consider the potential for VZV infection as well as herpes simplex virus infection in cases of aseptic meningitis accompanied by bladder and rectal disturbances, even in patients without any rash symptoms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Varicella Zoster Virus Meningoencephalitis Presenting with Elsberg Syndrome without a Rash in an Immunocompetent Patient

et al. 2015

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“…Some patients with spinal and paraspinal Exserohilum rostratum infections have been reported to exhibit similar nodules, although these lesions were limited to the leptomeninges and nerve roots from the lower lumbar through sacral level (6,7). Sacral nerve roots have also been found to be abnormal on T1-weighted images in patients with varicella-zoster virus (8) and herpes simplex virus 2 infections (9). Intriguingly, the present patient exhibited disseminated nodular lesions throughout the spinal cord on MRI that responded to treatment with voriconazole in conjunction with a clinical improvement.…”

Section: Discussionmentioning

confidence: 99%

Voriconazole-responsive Disseminated Nodular Lesions on Spinal MRI

et al. 2015

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A 74-year-old woman was hospitalized due to dysuria, weakness and dysesthesia of the lower extremities. She was in an immunosuppressed state following the administration of methylprednisolone therapy for idiopathic interstitial pneumonia. Cerebrospinal fluid and blood cultures were negative, and no infectious biomarkers were found. A gadolinium (Gd)-enhanced T1-weighted image of magnetic resonance imaging (MRI) revealed disseminated nodular lesions along the spinal cord. We suspected a diagnosis of seronegative deep mycosis and initiated anti-fungal therapy with voriconazole, which subsequently alleviated all of the patient's symptoms and MRI findings. Therefore, the presence of Gd-enhanced disseminated nodules on spinal MRI may be a good marker of deep meningeal mycosis.

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“…Radiculomyelitis causing transient urinary retention and sensory lumbosacral symptoms is known as Elsberg syndrome. 8 The most common diagnostic pitfall with VZV is its confusion with HSV infection. HSV lesions may appear in a dermatomal pattern, especially when involving the thighs or buttocks.…”

Section: Discussionmentioning

confidence: 99%

Varicella zoster virus infection causing urinary retention in a child with HIV infection

Wessels

2012

South. Afr. j. HIV med.

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Varicella zoster virus (VZV) of the human herpes virus family causes childhood chickenpox, becomes latent in sensory ganglia and re-activates years later in immunocompromised and elderly persons to produce shingles (herpes zoster). The annual incidence of herpes zoster in children aged <10 years is reported to be 0.74 per 1 000 children per year.1 The association of VZV infection and neurogenic bladder dysfunction is rare and mostly seen in adults, with only one reported case in a child. 2Severe and debilitating zoster-associated dermatological, ophthalmological and neurological complications may occur in patients with HIV infection. 3 We describe the case of an HIV-positive child who presented with acute urinary retention secondary to VZV infection. Case descriptionAn 11-year-old boy was referred with urinary retention. He complained of difficulty passing urine, lower abdominal discomfort, and a painful rash over the perineum for 5 days. His mother had noticed that he had lower abdominal swelling.The patient was HIV-positive and receiving treatment accordingly (300 mg zidovudine twice daily, 250 mg didanosine daily and 200 mg/50 mg lopinavir/ritonavir twice daily). He was also receiving treatment for pulmonary tuberculosis, diagnosed 6 months prior (300 mg rifampicin and 150 mg isoniazid daily). The boy had no previous history of chickenpox.On examination, the patient was pyrexial (temperature 39°C) and appeared acutely ill. His bladder was distended, easily palpable and mildly tender. His penis, scrotum and perineum over dermatomes S2 -S4 on the left were involved with a vesicular and superficially erosive rash. Severe swelling of the prepuce caused the appearance of phimosis (Fig. 1). On digital rectal examination, his anal tone was normal.The bulbocarvernosus reflex was not tested due to severe tenderness in the perineal area. No abnormalities were found on neurological examination of his lower limbs.An 8F Foley catheter was inserted transurethrally and 1 500 ml of clear urine was drained. The boy was admitted to hospital and treated with 300 mg acyclovir 6-hourly (intravenous), 4 drops of oral tilidine 6-hourly and 1 000 mg paracetamol 8-hourly.An 11-year-old boy receiving antiretroviral therapy for HIV infection and antibacterial therapy for pulmonary tuberculosis presented with urinary retention due to varicella zoster virus infection involving the sacral nerves, confirmed on serological testing. The perineum over dermatomes S2 -S4 on the left was involved with a vesicular and superficially erosive rash. A transurethral catheter was inserted and the patient was treated with acyclovir (300 mg 6-hourly for 5 days). At follow-up 4 weeks later, the perineal skin lesions had healed, the catheter was removed and the patient was able to pass urine.

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HSV-2 sacral radiculitis (Elsberg syndrome)

Cited by 88 publications

References 6 publications

Varicella Zoster Virus Meningoencephalitis Presenting with Elsberg Syndrome without a Rash in an Immunocompetent Patient

Varicella Zoster Virus Meningoencephalitis Presenting with Elsberg Syndrome without a Rash in an Immunocompetent Patient

Voriconazole-responsive Disseminated Nodular Lesions on Spinal MRI

Varicella zoster virus infection causing urinary retention in a child with HIV infection

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