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节段性带状疱疹性瘫痪致免疫低下患者持续发热

Segmental zoster paresis as a cause for persistent fever in an immunocompromised patient.

机构信息

Department of General Medicine, Tan Tock Seng Hospital, Singapore

Department of General Medicine, Tan Tock Seng Hospital, Singapore.

出版信息

BMJ Case Rep. 2021 Oct 19;14(10):e246015. doi: 10.1136/bcr-2021-246015.

Abstract

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.

摘要

带状疱疹再激活是一种常见的情况,可导致多种不常见的并发症。本病例报告强调了一种经常被忽视的并发症,即节段性带状疱疹性瘫痪。我们讨论了一例免疫功能低下的乳腺癌患者在疱疹样皮疹消退后,在 L2、L3 和 L4 皮节处出现发热和下肢无力的情况。在腰椎穿刺、寻找脑脊液白细胞增多、聚合酶链反应或分子检测检测水痘带状疱疹病毒以及针对水痘带状疱疹病毒的免疫球蛋白以支持诊断的情况下,应进行早期检查。神经传导研究、肌电图和脊柱 MRI 有时有助于神经定位。静脉注射阿昔洛韦和逐渐减少类固醇的疗程有助于缓解症状。斑驳的表现可能使诊断具有挑战性。提高认识和高度怀疑可以防止诊断和治疗的延迟,并改善患者的预后。

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