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Case Reports
. 2021 Oct 19;14(10):e246015.
doi: 10.1136/bcr-2021-246015.

Segmental zoster paresis as a cause for persistent fever in an immunocompromised patient

Affiliations
Case Reports

Segmental zoster paresis as a cause for persistent fever in an immunocompromised patient

Renuka Murali Govind et al. BMJ Case Rep. .

Abstract

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.

Keywords: infection (neurology); infectious diseases; neurology; peripheral nerve disease.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Tense vesicobullae on medical aspect of ankle with surrounding crop of vesicles and purpuric papules on first admission.
Figure 2
Figure 2
Deroofed bulla over left ankle with crusting and dry herpetiform lesions after 3 days of intravenous acyclovir at the end of the first admission.
Figure 3
Figure 3
Dry and crusted herpes zoster lesions on second admission.

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