Non-Adjacent Bilateral Postherpetic Neuralgia in a Multiple Myeloma Patient: A Case Report

Abstract

BACKGROUND Postherpetic neuralgia is a refractory neuropathic pain that persists after healing from an acute herpes zoster infection. The pain is often perceived as a sensation akin to needling, cauterization, or electric shock. Clinically, it often manifests with unilateral onset, whereas patients with different sides and multiple segments of postherpetic neuralgia have not yet been reported. Owing to the incompletely elucidated pathogenesis, the therapeutic effects of currently available treatments in different patients are heterogenous, resulting in enormous pain. The risk factors for PHN include age >60 years, malignant tumors, diabetes, and immune dysfunction. CASE REPORT We report a case of a 65-year-old man with multiple myeloma who developed left T3 and right T11 postherpetic neuralgia. We used drugs as the basic treatment and then combined nerve pulse radio frequency, nerve block, and other treatments. After discharge, we followed up the patient for 3 months, gradually reducing the dose to wean the patient off the drug treatment, and intermittent pain occasionally occurred. The numerical rating scale score was 0-1 points, which is pain that does not affect daily activities or sleep. CONCLUSIONS We report a rare case of postherpetic neuralgia with multiple myeloma occurring on different sides, but not on adjacent nerve segments. We performed left T3 and right T11 nerve pulse radiofrequency surgery, after poor drug treatment efficacy, followed by postoperative nerve block therapy; then, the patient's pain had been effectively controlled. We hope that our case can provide reference for doctors who encounter similar cases in the future.

Figure 1

(A) The patient’s frontal view shows significant skin pigmentation (black arrow) in the left chest (T3 segment) and right abdomen (T11 segment). (B) The patient also had pigmentation on the skin of the same nerve segment on the back. The pain also came from the skin pigmentation areas shown in figures a and b above.

Figure 2

(A–D) The patient’s thoracic MRI showed no intraspinal- or extraspinal-related lesions, intervertebral disc herniation, spinal cord lesions, intraspinal tumors, or vertebral fractures.

Figure 3

(A) In the prone position, digital subtraction angiography (DSA)-guided T3 and T11 nerve pulse radiofrequency anteroposterior films were taken, with the tip of the radiofrequency puncture needle (black arrow) located below the external pedicle of the vertebral arch. (B) DSA-guided T3 and T11 nerve pulse radiofrequency lateral films are shown, with the tip of the radiofrequency puncture needle located in the upper middle of the intervertebral foramen.