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酷似坐骨神经痛的水痘-带状疱疹神经根炎:诊断难题

Varicella-Zoster Radiculitis Mimicking Sciatica: A Diagnostic Dilemma.

作者信息

Mallepally Abhinandan Reddy, Mahajan Rajat, Rustagi Tarush, Marathe Nandan Amrit, Chhabra Harvinder Singh

机构信息

Spinal Services, Indian Spinal Injuries Centre, New Delhi, India.

出版信息

Asian J Neurosurg. 2020 Aug 28;15(3):666-669. doi: 10.4103/ajns.AJNS_75_20. eCollection 2020 Jul-Sep.

Abstract

Varicella-zoster virus (VZV) presenting as a radicular pain in the thoracic region is not uncommon, but the presentation in the lumbar and thigh region is not frequently seen. Characteristic segmental vesicular-bullous rash in a dermatomal distribution associated with pain and allodynia is a prominent feature. The pain appears before rash. It is not uncommon for clinicians to misdiagnose radicular pain caused by VZV due to prolapsed disc. We report two patients who presented to us with complaints of back pain with leg radiculopathy that were initially treated for discogenic radiculopathy and rash was wrongly attributed to hot fomentation. This case report emphasizes the importance of including varicella-zoster radiculitis in the differential diagnosis of radicular pain and clinical examination of every rash. Physical examination is must if the patient complains of rash. Appropriate and timely diagnosis can prevent unnecessary investigations.

摘要

水痘带状疱疹病毒(VZV)表现为胸部神经根性疼痛并不罕见,但在腰部和大腿区域的表现并不常见。特征性的节段性水疱大疱性皮疹呈皮节分布,伴有疼痛和痛觉过敏,是一个突出特征。疼痛出现在皮疹之前。临床医生因椎间盘突出而误诊由VZV引起的神经根性疼痛并不少见。我们报告了两名患者,他们因背痛伴腿部神经根病前来就诊,最初被诊断为椎间盘源性神经根病,皮疹被错误地归因于热敷。本病例报告强调了在神经根性疼痛的鉴别诊断中纳入水痘带状疱疹神经根炎以及对每一例皮疹进行临床检查的重要性。如果患者主诉有皮疹,体格检查是必需的。及时恰当的诊断可以避免不必要的检查。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/74c1/7591216/aceb5bfee131/AJNS-15-666-g001.jpg

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