Herpes zoster sciatica mimicking lumbar canal stenosis: a case report

BMC Research Notes

Takeo Furuya²  Masashi Yamazaki³  Osamu Ikeda²  Akihiko Okawa²  Tamiyo Kon¹  Yuzuru Okamoto¹  Masazumi Murakami¹  Makiko Oikawa⁴  Chikato Mannoji¹  Masao Koda¹ 

[1] Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan;Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba 260-8670, Japan;Department of Orthopedic Surgery, Tsukuba University, Ibaraki, Japan;Department of Dermatology, Chiba Aoba Municipal Hospital, Chiba, Japan

关键词: Diagnosis;    Lumbar spinal canal stenosis;    Herpes zoster;   

Others  :  1230934
DOI  :  10.1186/s13104-015-1272-z

 received in 2015-05-13, accepted in 2015-07-07,  发布年份 2015

【 摘 要 】

Background

Symptom of herpes zoster is sometimes difficult to distinguish from sciatica induced by spinal diseases, including lumbar disc herniation and spinal canal stenosis. Here we report a case of sciatica mimicking lumbar canal stenosis.

Case presentation

A 74-year-old Chinese male patient visited our hospital for left-sided sciatic pain upon standing or walking for 5 min of approximately 1 month’s duration. At the first visit to our hospital, there were no skin lesions. A magnetic resonance imaging showed spinal canal stenosis between the 4th and 5th lumbar spine. Thus, we diagnosed the patient with sciatica induced by spinal canal stenosis. We considered decompression surgery for the stenosis of 4th and 5th lumbar spine because conservative therapy failed to relieve the patient’s symptom. At that time, the patient complained of a skin rash involving his left foot for several days. A vesicular rash and erythema were observed on the dorsal and plantar surfaces of the great toe and lateral malleolus. The patient was diagnosed with herpes zoster in the left 5th lumbar spinal nerve area based on clinical findings, including the characteristics of the pain and vesicular rash and erythema in the 5th lumbar spinal dermatome. The patient was treated with famciclovir (1,500 mg/day) and non-steroidal anti-inflammatory drugs. After 1 week of medication, the skin rash resolved and pain relief was obtained.

Conclusion

In conclusion, spinal surgeons should keep in mind herpes zoster infection as one of the possible differential diagnoses of sciatica, even if there is no typical skin rash.

【 授权许可】

   
2015 Koda et al.

【 图 表 】

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【 参考文献 】

• [1]Wilson JF: Herpes zoster. Ann Intern Med 2011, 154:1-15.
• [2]Leo AM, Kasper DA, Saxena A: Atypical herpes zoster infection preceded by sciatica and foot drop. Arch Dermatol 2009, 145:954-955.
• [3]Sprenger De Rover WB, Alazzawi S, Hallam PJ, Hutchinson R, Di Mascio L: Herpes zoster virus: an unusual but potentially treatable cause of sciatica and foot drop. Orthopedics 2011, 34:e965-e968.