Herpes zoster segmental paresis in an immunocompromised breast cancer woman

Rastegar, Shirvan; Mahdavi, Sadegh Baradaran; Mahmoudi, Farhad; Basiri, Keivan

Herpes zoster segmental paresis in an immunocompromised breast cancer woman

Authors

¹ Department of Orthopedics, Alzahra Hospital, Isfahan University of Medical sciences, Isfahan, Iran

² Medical Students' Research Center; Neurosciences Research Center, Isfahan University of Medical sciences, Isfahan, Iran

³ Medical Students' Research Center, Isfahan University of Medical sciences, Isfahan, Iran

⁴ Neurosciences Research Center, Isfahan University of Medical sciences, Isfahan, Iran

Abstract

Herpes zoster is an infectious disease with neurological complications caused by reactivation of varicella zoster virus in dorsal root ganglia of spinal cord which is also known as "Shingles." Suppression of immune system is the major predisposing factor for reactivation of latent virus. Disease is mainly characterized by rash, vesicles and pain along one or more dermatomes which are innervated from one or more spinal nerve roots. Complications may be present after a while despite of patient treatment. Motor involvement is included. Some previous studies showed segmental zoster paresis as a rare complication, a few weeks after first presentation, among immunocompetent individuals. We present post herpetic motor involvement of C5 and C6 in a 59-year-old woman who underwent chemotherapy and radiotherapy due to breast cancer, manifesting left upper limb weakness and paresis, 6 months after left partial mastectomy. Segmental paresis of zoster virus should be considered as a cause of motor impairment in an immunocompromised person suffering from shingles.

Keywords

References

1.	Dworkin RH, Johnson RW, Breuer J, Gnann JW, Levin MJ, Backonja M, et al. Recommendations for the management of herpes zoster. Clin Infect Dis 2007;44:S1-26.
2.	Yawn BP, Saddier P, Wollan PC, St Sauver JL, Kurland MJ, Sy LS. A population-based study of the incidence and complication rates of herpes zoster before zoster vaccine introduction. Mayo Clin Proc 2007;82:1341-9.
3.	Jumaan AO, Yu O, Jackson LA, Bohlke K, Galil K, Seward JF. Incidence of herpes zoster, before and after varicella-vaccination-associated decreases in the incidence of varicella, 1992-2002. J Infect Dis 2005;191:2002-7.
4.	Taha Y, Scott FT, Parker SP, Syndercombe Court D, Quinlivan ML, Breuer J. Reactivation of 2 genetically distinct varicella-zoster viruses in the same individual. Clin Infect Dis 2006;43:1301-3.
5.	Gebo KA, Kalyani R, Moore RD, Polydefkis MJ. The incidence of, risk factors for, and sequelae of herpes zoster among HIV patients in the highly active antiretroviral therapy era. J Acquir Immune Defic Syndr 2005;40:169-74.
6.	Rowbotham M, Harden N, Stacey B, Bernstein P, Magnus-Miller L. Gabapentin for the treatment of postherpetic neuralgia: A randomized controlled trial. JAMA 1998;280:1837-42.
7.	Elliott KJ. Other neurological complications of herpes zoster and their management. Ann Neurol 1994;35:S57-61.
8.	Ruppert LM, Freeland ML, Stubblefield MD. Segmental zoster paresis of the left upper limb in a pediatric patient. Am J Phys Med Rehabil 2010;89:1024-9.
9.	Tashiro S, Akaboshi K, Kobayashi Y, Mori T, Nagata M, Liu M. Herpes zoster-induced trunk muscle paresis presenting with abdominal wall pseudohernia, scoliosis, and gait disturbance and its rehabilitation: A case report. Arch Phys Med Rehabil 2010;91:321-5.
10.	Yaszay B, Jablecki CK, Safran MR. Zoster paresis of the shoulder. Case report and review of the literature. Clin Orthop Relat Res 2000;377:112-8.
11.	Choo PW, Galil K, Donahue JG, Walker AM, Spiegelman D, Platt R. Risk factors for postherpetic neuralgia. Arch Intern Med 1997;157:1217-24.
12.	Gopal KV, Sarvani D, Krishnam Raju PV, Rao GR, Venkateswarlu K. Herpes zoster motor neuropathy: A clinical and electrophysiological study. Indian J Dermatol Venereol Leprol 2010;76:569-71. [PUBMED]
13.	Grant BD RC. Motor paralysis of the extremities in herpes zoster. J Bone Joint Surg 1961;43:885-96.
14.	Caridi JM, Pumberger M, Hughes AP. Cervical radiculopathy: A review. HSS J 2011;7:265-72.
15.	Postacchini F. Lumbar Disc Herniation. New York: Springer Wien; 1999.
16.	Persson LC, Moritz U, Brandt L, Carlsson CA. Cervical radiculopathy: pain, muscle weakness and sensory loss in patients with cervical radiculopathy treated with surgery, physiotherapy or cervical collar. A prospective, controlled study. Eur Spine J 1997;6:256-66.
17.	Gosk J, Rutowski R, Urban M, Wiecek R, Rabczynski J. Brachial plexus injuries after radiotherapy - analysis of 6 cases. Folia Neuropathol 2007;45:31-5.
18.	Burns RJ. Delayed radiation-induced damage to the brachial plexus. Clin Exp Neurol 1978;15:221-7.
19.	Johansson S, Svensson H, Larsson LG, Denekamp J. Brachial plexopathy after postoperative radiotherapy of breast cancer patients-a long-term follow-up. Acta Oncol 2000;39:373-82.
20.	Cockerell OC, Ormerod IE. Focal weakness following herpes zoster. J Neurol Neurosurg Psychiatry 1993;56:1001-3.
21.	Kawajiri S, Tani M, Noda K, Fujishima K, Hattori N, Okuma Y. Segmental zoster paresis of limbs: Report of three cases and review of literature. Neurologist 2007;13:313-7.
22.	Galecki J, Hicer-Grzenkowicz J, Grudzien-Kowalska M, Michalska T, Zalucki W. Radiation-induced brachial plexopathy and hypofractionated regimens in adjuvant irradiation of patients with breast cancer-a review. Acta Oncol 2006;45:280-4.

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