Schuchmann John A, McAllister Russell K, Armstrong Christopher S, Puana Rudolph
Department of Physical Medicine and Rehabilitation, Scott & White Memorial Hospital, Texas A&M Health Sciences Center College of Medicine, Temple, Texas 76508, USA.
Am J Phys Med Rehabil. 2008 Oct;87(10):853-8. doi: 10.1097/PHM.0b013e318186c049.
Reactivation of latent varicella-zoster virus can occur when the immune system is weakened leading to the typical presentation seen with herpes zoster or shingles. In a small percentage of these patients, motor paralysis can be seen in the affected myotomal distribution. Zoster sine herpete, or shingles without the typical vesicular rash, is an uncommon variant of zoster. Systemic steroids are known to weaken the immune response. Two previous case reports have implicated epidural steroid injections as a precipitating cause of zoster. We present a case of serologically verified zoster sine herpete producing an abdominal wall bulge, which occurred 1 wk after thoracic epidural steroid injection. Electromyography documented the presence of abdominal wall denervation. Given the low incidence of serologically proven zoster sine herpete--especially with thoracic motor paralysis--and the equally rarely documented incidence of zoster related to epidural steroids, we present what we believe to be the first reported case of zoster sine herpete with a neuropathic abdominal wall bulge occurring in close temporal association to receiving epidural steroids.
当免疫系统减弱时，潜伏的水痘 - 带状疱疹病毒可能会重新激活，导致出现带状疱疹或蛇串疮的典型表现。在这些患者中，一小部分会在受影响的肌节分布区域出现运动性麻痹。无疹性带状疱疹，即没有典型水疱疹的带状疱疹，是带状疱疹的一种罕见变体。已知全身用类固醇会削弱免疫反应。之前有两份病例报告指出硬膜外类固醇注射是带状疱疹的诱发原因。我们报告一例经血清学证实的无疹性带状疱疹病例，该病例在胸段硬膜外类固醇注射1周后出现腹壁膨出。肌电图证实存在腹壁去神经支配。鉴于经血清学证实的无疹性带状疱疹发病率较低——尤其是伴有胸段运动性麻痹的情况——以及与硬膜外类固醇相关的带状疱疹发病率同样鲜有记录，我们呈现了我们认为是首例报告的与接受硬膜外类固醇密切相关的无疹性带状疱疹伴神经性腹壁膨出病例。
