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Case Reports
. 2020 Aug 19;4(5):608-610.
doi: 10.1016/j.mayocpiqo.2020.06.001. eCollection 2020 Oct.

Acute Herpes Zoster Radiculopathy of the Lower Extremity With Dermatomal Rash and Lumbar Nerve Enhancement on MRI

Samay Bhushan  1 , Lisette Dominguez  2 , Ehsan Shirazi  3 , Vivek Gupta  1
Affiliations
Case Reports

Acute Herpes Zoster Radiculopathy of the Lower Extremity With Dermatomal Rash and Lumbar Nerve Enhancement on MRI

Samay Bhushan et al. Mayo Clin Proc Innov Qual Outcomes. .

Abstract

Herpes zoster is a frequent cause of neuralgia and dermatomal vesicular rash secondary to reactivation of latent varicella zoster virus. However, it rarely presents with acute lumbar radiculopathy and the diagnosis can be quite challenging in such cases. Nerve signal abnormalities on magnetic resonance imaging are well recognized in herpes zoster neuropathy or plexopathy affecting the extremities, although gadolinium enhancement is characteristically absent. In this article, we describe a case of acute herpes zoster lumbosacral radiculopathy with characteristic vesicular dermatomal rash and second ever reported finding of gadolinium enhancement of the lumbar nerve on magnetic resonance imaging.

Keywords: MRI, magnetic resonance imaging; VZV, varicella zoster virus.

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Figures

Figure
Figure
A, Four centimeter vesicular erythematous rash and another 1 cm erythematous rash in the L5/S1 dermatome of the left calf. B and C, Enhanced axial T1-weighted magnetic resonance imaging displaying enlargement of the left L5 dorsal root ganglion (arrow) and abnormal enhancement of the descending left L5 nerve (arrowhead).
See this image and copyright information in PMC

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