Transverse myelitis in an immunocompetent patient after an episode of trigeminal Herpes zoster: case report and literature review
Gonzalez-Ramos, M.M.; Bertran-Pasarell, J.; Sanchez-Sergenton, C.
Boletin de la Asociacion Medica de Puerto Rico 97(1): 77-81
2005
ISSN/ISBN: 0004-4849 Document Number: 703037
Transverse myelitis as a consequence of herpes zoster has been occasionally reported in the medical literature, and most of these cases were observed in immunocompromised patients and in the elderly. We report the neurologic complications of a young, immuno-competent patient after suffering an episode of trigeminal herpes zoster. A 29 year old female with history of recently diagnosed diabetes, well controlled with oral medication, was admitted on May 2004 due to abdominal pain, nausea, vomiting, and paresthesias of the left side of the face, left side of the abdomen, and the right upper and lower extremities. The patient had suffered an episode of trigeminal herpes zoster three weeks prior to admission which had been treated with oral famcyclovir. Her neurologic deficit progressed to quadriparesis, urinary retention, and constipation for which an initial assessment of transverse myelitis was made and confirmed with magnetic resonance imaging of the spine. Cerebrospinal fluid was negative for infectious etiologies and demyelinating disease. The patient was treated with intravenous acyclovir and corticosteroids with partial recuperation of the motor and sensory deficits. The neurologic complications observed in this young, immunocompetent patient are unusual and unexpected, mostly because of the lack of cervical or thoracic dermatomal involvement which usually precedes the type of lesion observed in her imaging studies. To our knowledge, the development of transverse myelitis after trigeminal herpes zoster, has not been previously reported. A review of the literature on transverse myelitis secondary to varicella zoster virus is also included.
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