Zhou Junli, Li Juan, Ma Lulin, Cao Song
Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China.
Korean J Pain. 2020 Jul 1;33(3):208-215. doi: 10.3344/kjp.2020.33.3.208.
Zoster sine herpete (ZSH) is one of the atypical clinical manifestations of herpes zoster (HZ), which stems from infection and reactivation of the varicella-zoster virus (VZV) in the cranial nerve, spinal nerve, viscera, or autonomic nerve. Patients with ZSH display variable symptoms, such as neuralgia, however, different from HZ, ZSH show no zoster, which makes clinical diagnosis difficult. ZSH not only causes initial symptoms, such as neuropathic pain in the affected nerve, Bell palsy, and Ramsay Hunt syndrome, but also postherpetic neuralgia and fatal complications such as VZV encephalitis and stroke. The misdiagnosis of ZSH and tardy antiviral treatment may lead to severe ZSH sequelae. We review the publications related to ZSH, especially its diagnosis with VZV DNA and/or anti-VZV immunoglobulin (IgG and IgM). More work about ZSH, especially ZSH epidemiological survey and guidelines for its diagnosis and treatment, are needed because most of the present studies are case reports.
无疹性带状疱疹（ZSH）是带状疱疹（HZ）的非典型临床表现之一，它源于水痘-带状疱疹病毒（VZV）在颅神经、脊神经、内脏或自主神经中的感染和再激活。ZSH患者表现出多种症状，如神经痛，然而，与HZ不同的是，ZSH没有皮疹，这使得临床诊断困难。ZSH不仅会引发初始症状，如受累神经的神经性疼痛、贝尔麻痹和拉姆齐·亨特综合征，还会导致带状疱疹后神经痛以及VZV脑炎和中风等致命并发症。ZSH的误诊和抗病毒治疗延迟可能会导致严重的ZSH后遗症。我们回顾了与ZSH相关的文献，特别是其通过VZV DNA和/或抗VZV免疫球蛋白（IgG和IgM）进行的诊断。由于目前大多数研究都是病例报告，因此需要开展更多关于ZSH的工作，尤其是ZSH的流行病学调查及其诊断和治疗指南。
