Viral lumbosacral radiculitis (Elsberg syndrome) in Denmark

Abstract

Purpose: To describe clinical features and outcomes of viral lumbosacral radiculitis (Elsberg syndrome).

Methods: Nationwide population-based cohort study of all adults hospitalised for viral lumbosacral radiculitis at departments of infectious diseases in Denmark from 2015 to 2020.

Results: Twenty-eight patients with viral lumbosacral radiculitis were included (mean annual incidence: 1.2/1,000,000 adults). The median age was 35 years (IQR 27-43), and 22/28 (79%) were female. All patients had urinary retention, with 17/28 (61%) needing a catheter. On admission, at least one sign or symptom of meningitis (headache, neck stiffness, photophobia/hyperacusis) was present in 18/22 (82%). Concurrent genital herpetic lesions were present in 11/24 (46%). The median cerebrospinal fluid leukocyte count was 153 cells/µL (IQR 31-514). Magnetic resonance imaging showed radiculitis/myelitis in 5/19 (26%). The microbiological diagnosis was herpes simplex virus type 2 in 19/28 (68%), varicella-zoster virus in 2/28 (7%), and unidentified in 7/28 (25%). Aciclovir/valaciclovir was administered in 27/28 (96%). At 30 days after discharge, 3/27 (11%) had persistent urinary retention with need of catheter. At 180 days after discharge, moderate disabilities (Glasgow Outcome Scale score of 4) were observed in 5/25 (20%).

Conclusions: Urinary retention resolved within weeks in most patients with viral lumbosacral radiculitis, but moderate disabilities according to the Glasgow Outcome Scale were common at the end of follow-up.

Keywords: Aciclovir; Aseptic meningitis; Herpesviridae; Myelitis; Urinary retention; Viral meningitis.

Fig. 1

Cerebrospinal fluid leukocyte count by aetiology in adults with viral lumbosacral radiculitis. Box is interquartile range, horizontal line is median, and whiskers are range

Fig. 2

Microbiological tests in adults with viral lumbosacral radiculitis. EV enterovirus, HSV herpes simplex virus, IAI intrathecal antibody index