Abdominal pseudohernia as an exceptional complication of herpes-zoster

Abstract

Introduction: Herpes zoster (HZ), caused by the reactivation of the Varicella-Zoster virus, is typically characterized by sensory complications. However, motor complications, such as abdominal pseudohernia, are rare and exceptional. This report presents a case of post-herpes zoster pseudo-hernia in a previously healthy 54-year-old man.

Case presentation: A 54-year-old Caucasian patient developed an abdominal wall protrusion over two weeks, following a resolved herpes zoster infection. Physical examination revealed healed skin lesions and a painless protrusion on the right flank, triggered by coughing, suggesting an abdominal wall hernia. Abdominal CT scan ruled out parietal but noted asymmetry in the abdominal wall muscles, particularly thinning on the right side. The diagnosis of post-herpes zoster pseudo-hernia was established, with spontaneous resolution occurring after four months.

Discussion: Herpes zoster typically manifests as a sensory condition. However, motor complications can lead to muscle weakness or paralysis. Pseudo-herniation is a rare motor complication, affecting less than 1 % of cases. It must be differentiated from true abdominal wall hernias, which require surgical intervention. Pseudo-hernia typically presents as painless abdominal bulging, often asymptomatic, but can lead to gastrointestinal issues if visceral nerves are affected. Imaging studies and EMG may be employed for diagnosis. Treatment for pseudo-hernia is conservative, addressing the underlying HZ, and the prognosis is favorable, with most cases resolving within 3 to 12 months.

Conclusion: Abdominal post-herpes zoster pseudo-hernia is a rare HZ complication. Recognizing this entity is crucial, as it typically resolves spontaneously without surgical intervention. This case aims to enhance awareness of this exceptional clinical manifestation.

Keywords: Case report; Diagnosis; Herpes-zoster; Management; Pseudohernia.

Fig. 1

: Skin lesions due to herpes-zoster.

Fig. 2

Abdominal bulge on the right flank.

Fig. 3

CT scan showing asymetrical muscles of the abdominal wall (yellow arrows) but no defect. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)