Herpes Zoster Confused with Radiculopathy

Young-Joon Ahn; Changju Hwang; Kyeong-Il Jeong; Sung-Woo Lee; Yung-Tae Kim; Dong-Ho Lee; Choon Sung Lee

doi:10.4055/jkoa.2008.43.4.405

Journal List > J Korean Orthop Assoc > v.43(4) > 1012801

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Ahn, Hwang, Jeong, Lee, Kim, Lee, and Lee: Herpes Zoster Confused with Radiculopathy

Original Article

Journal of the Korean Orthopaedic Association

Journal of the Korean Orthopaedic Association 2008; 43(4): 405-412.

Published online: 31 August 2008

DOI: https://doi.org/10.4055/jkoa.2008.43.4.405

Herpes Zoster Confused with Radiculopathy

Young-Joon Ahn, M.D.^*, Changju Hwang, M.D., Kyeong-Il Jeong, M.D.^†, Sung-Woo Lee, M.D., Yung-Tae Kim, M.D., Dong-Ho Lee, M.D., Choon Sung Lee, M.D.

Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.

^*National Police Hospital, Seoul, Korea.

^†Choi Hospital, Cheongju, Korea.

Address reprint requests to Choon Sung Lee, M.D. Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, 388-1, Poongnap-dong, Songpa-gu, Seoul 138-736, Korea. Tel: +82.2-3010-3530, Fax: +82.2-488-7877, cslee@amc.seoul.kr

Abstract

Purpose

To describe the clinical features of herpes zoster that can be easily misdiagnosed as cervical or lumbar radiculopathy.

Materials and Methods

We retrospectively reviewed the medical records and diagnostic studies of 7 patients with herpes zoster-related arm or leg pain.

Results

Except one immunocompromised patient with suspected postherpetic neuralgia or sequelae of herpetic myelitis, the other 6 patients with herpes zoster complained of very severe initial pain of sudden onset. Three patients did not show skin lesions on initial examination, and 2 of 5 patients with an MRI of the cervical or lumbar spine had findings consistent with their arm or leg pain and may have been confused with radiculopathy. Conservative treatment, including antiviral agents, improved the symptoms of all patients except the immunocompromised one. Selective nerve root blocks of the corresponding dermatomes were performed in 5 patients and extremity pain decreased over 50% in 4 of them.

Conclusion

Herpes zoster can be confused with radiculopathy in patients with arm or leg pain if the typical skin lesions have not been developed. Unnecessary treatments including surgery should be avoided by early, correct diagnosis through prudent history taking and physical examination.

Keywords: Arm or leg pain, Radiculopathy, Herpes zoster, Postherpetic neuralgia, Myelitis

Figures and Tables

Fig. 1

T2 axial (A) and sagittal (B) MRI images showing compression of right 6th cervical nerve by a hard disc (Case 1).

Fig. 2

Grouped erythematous vesicles in C5 and C6 dermatomes of right arm. The patient complained of pruritus in this area (Case 1).

Fig. 3

Clusters of erythematous papules in L5 and S1 dermatomes of left leg (Case 2).

Table 1

Summary of Clinical Features

F, Female; M, Male; A, Time period from the onset of prodromal pain to the appearance of skin rash; B, Total duration of pain; SLR, Limitation of straight leg raising or Spurling sign; MH, Medical history; DSL, Degenerative spondylolisthesis; SS, Spinal stenosis; ESI, Epidural steroid injection.

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