Myelorradiculitis due to Varicella Zoster (Elsberg syndrome) as the first symptom of HIV in a patient with Crohn's disease in use of Infliximab

Santos, Diogo Haddad; Oliveira, Roberto de; Fernandes, Wilson Rodrigues; Olivetti, Bruno Casola

doi:10.1016/j.msard.2020.102643

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…Antiviral drugs are recommended for the resolution of herpes zoster lesions and to decrease the severity of acute pain 3 . Although the correct acyclovir regimen for ES caused by VZV has not been established, 3 the usual dose that is administered is 5–10 mg/kg q8h for ES without meningitis and 10 mg/kg q8h for ES with meningitis or ES in immunocompromised hosts 9,10 . In the present case, because the only neurological symptom was voiding dysfunction, we administered 5 mg/kg q8h, considering the risk of adverse effects, such as renal toxicity or acyclovir‐induced neurotoxicity, with increasing doses.…”

Section: Discussionmentioning

confidence: 97%

“…3 Although the correct acyclovir regimen for ES caused by VZV has not been established, 3 the usual dose that is administered is 5-10 mg/kg q8h for ES without meningitis and 10 mg/kg q8h for ES with meningitis or ES in immunocompromised hosts. 9,10 In the present case, because the only neurological symptom was voiding dysfunction, we administered 5 mg/kg q8h, considering the risk of adverse effects, such as renal toxicity or acyclovirinduced neurotoxicity, with increasing doses. According to the patient's neurological condition (consistent with meningitis, disseminated lesions, and weakness or paralysis of the lower extremities) and background (age and immunocompromised status due to HIV infection), an individualized dose of acyclovir was considered reasonable.…”

Section: Discussionmentioning

confidence: 99%

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Elsberg syndrome caused by herpes zoster in the sacral region with preceding urinary retention

Nishiyama

Yoshimura

Shimizuhira

et al. 2023

Acute Medicine & Surgery

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Background Elsberg syndrome (ES) is an acute‐onset lumbosacral radiculitis with myelitis caused by a herpes virus infection. Case Presentation We present a case of a 77‐year‐old woman who was admitted with urinary retention prior to genital rash. The patient was diagnosed with ES and treated with intravenous acyclovir 250 mg every 8 h for 1 week. Conclusion Physicians should consider ES in patients with voiding dysfunction, as preceding neurological symptoms may lead to a misdiagnosis. Considering the adverse effects of the antiviral drug, its dosage should be according to the causative virus of the ES as well as the patient's age and medical history.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Elsberg syndrome caused by herpes zoster in the sacral region with preceding urinary retention

Nishiyama

Yoshimura

Shimizuhira

et al. 2023

Acute Medicine & Surgery

View full text Add to dashboard Cite

show abstract

“…Although the patient had a partial recovery at discharge, the long-term prognosis was not reported. These cases suggest that short-term treatment with corticosteroid and acyclovir may be ineffective in improving the short-term prognosis [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Extensive Transverse Myelitis due to Varicella‐Zoster Virus Infection in an Undiagnosed HIV‐Positive Patient

Yaghmaei,

Najafi,

Daneshvar Kakhki

2024

Case Reports in Neurological Medicine

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Introduction. Longitudinal extensive transverse myelitis (LETM) has four main causes: inflammatory, malnutrition, vascular, and infectious causes. Among the commonly described viral causes leading to LETM are the Herpesviridae family, HIV, and HTLV‐1. Case Presentation. A 43‐year‐old man presented with asymmetric weakness of the lower limbs (the left side was weaker), urinary retention, and flank pain. The symptoms began five days after shingle eruption and progressed over twelve days. He was diagnosed with longitudinal extensive transvers myelitis extending from T4 to T6, which corresponded to the same dermatome involved in shingles. The PCR result of cerebrospinal fluid was positive for varicella‐zoster virus with a viral load of 500 copies/ml. Additionally, the initial HIV enzyme‐linked immunosorbent assay (ELISA) test was positive, and his CD4 count was 72 cells/mm3. Other lab results were normal. Based on the appearance of LETM in the thoracic MRI at T4‐T6, VZV myelitis was diagnosed, and treatment was initiated with acyclovir (30 mg/kg divided daily for twenty‐one days), methylprednisolone (1 g/day for three days), prophylactic antibiotics (trimethoprim/sulfamethoxazole, rifampin, and isoniazid), and antiretroviral therapy (dolutegravir and Truvada). After 2‐month follow‐up, he was nearly free of symptoms. Conclusion. Infection is one of the critical causes of transverse myelitis. When a patient presents with skin shingles along with myelopathy, varicella‐zoster myelitis should be considered, and the patient should be evaluated in terms of immune system dysfunction. Treatment with acyclovir has been shown to be effective in reducing clinical symptoms in such cases.

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Varicella-zoster virus infection and autonomic dysfunction

Sakakibara

Sawai

Ogata

2022

Autonomic Neuroscience

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Myelorradiculitis due to Varicella Zoster (Elsberg syndrome) as the first symptom of HIV in a patient with Crohn's disease in use of Infliximab

Cited by 5 publications

References 9 publications

Elsberg syndrome caused by herpes zoster in the sacral region with preceding urinary retention

Elsberg syndrome caused by herpes zoster in the sacral region with preceding urinary retention

Longitudinal Extensive Transverse Myelitis due to Varicella‐Zoster Virus Infection in an Undiagnosed HIV‐Positive Patient

Varicella-zoster virus infection and autonomic dysfunction

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