J Korean Orthop Assoc.  2008 Aug;43(4):405-412. 10.4055/jkoa.2008.43.4.405.

Herpes Zoster Confused with Radiculopathy

Affiliations
  • 1Department of Orthopaedic Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. cslee@amc.seoul.kr
  • 2Department of Orthopaedic Surgery, National Police Hospital, Seoul, Korea.
  • 3Choi Hospital, Cheongju, Korea.

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.

Keyword

Arm or leg pain; Radiculopathy; Herpes zoster; Postherpetic neuralgia; Myelitis

MeSH Terms

Antiviral Agents
Arm
Extremities
Herpes Zoster
Humans
Immunocompromised Host
Leg
Medical Records
Myelitis
Neuralgia, Postherpetic
Radiculopathy
Retrospective Studies
Skin
Spine
Antiviral Agents

Figure

  • 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).


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