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   Introduction
   Case Report
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CASE REPORT
Year : 1992  |  Volume : 58  |  Issue : 1  |  Page : 37-38

Herpes zoster with ipsilateral limb oedema and arthritic changes


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Correspondence Address:
Kumar Ashok Khare


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  Abstract 

A 60-year old female who developed herpes zoster in the distribution of C 6 - 7 on the left upper arm, is reported because of some unusual features. With onset of herpes zoster, she developed ipsilateral painful limb oedema. After healing of cutaneous lesions of herpes zoster the limb oedema was associated with marked restriction of joint movements in the same limb for about 4 months. Roentgenogram of the involved part showed soft tissue swelling with arthritic changes.


Keywords: Herpes Zoster, Ipsilateral limb oedema, Arthritis


How to cite this article:
Khare KA, Kachhawa D, Khullar R, Sing. Herpes zoster with ipsilateral limb oedema and arthritic changes. Indian J Dermatol Venereol Leprol 1992;58:37-8

How to cite this URL:
Khare KA, Kachhawa D, Khullar R, Sing. Herpes zoster with ipsilateral limb oedema and arthritic changes. Indian J Dermatol Venereol Leprol [serial online] 1992 [cited 2014 Sep 20];58:37-8. Available from: http://www.ijdvl.com/text.asp?1992/58/1/37/3740



  Introduction Top


The commonest sequel of herpes zoster (HZ) is post-herpetic neuralgia. Some other complications such as superficial gangrene, ocular involvement, haematogenous dissemination, myelitis or encephalitis may also occur. [1] Paralysis of limb, [2],[3] diaphragmatic paralysis, [4] dysfunction of bladder [5],[6],[7],[8] anus [6] have also been reported in association with HZ. We are herein reporting a 60-year-old female who had HZ with some unusual features like ipsilateral painful limb oedema and restriction of joint movements with arthritic changes in roentgenogram.


  Case Report Top


A 60-year-old female presented with typical HZ lesions of 2 days duration in the distribution of C6-7 on the left upper arm. It was associated with painful oedema of whole of the left upper extremity. She was prescribed silver sulphadiazine cream topically with oral ibuprofen and diazepam. The lesions of HZ healed completely in next 15 days but there was persistence of oedema of whole left upper limb [Figure - 1] as well as pain. After a week, there was restriction of movements in all the joints of left upper extremity. NSAID's like piroxicam, mefenamic acid, acetylsalicylic acid were not of much use. Routine laboratory tests on blood, urine and stool did not show any abnormality.

Roentgenogram of the involved joints showed arthritic changes in the interphalangeal joints [Figure - 2].

After 4 months, the condition showed some improvement in the form of reduction in the limb oedema as well as pain. The movement at joints became relatively better.

The patient attributed this improvement to chloroquine therapy which she received for malaria about 15 days back.


  Comments Top


The inflammatory features are usually localised in cases of HZ but sometimes relatively distant effects have also been recorded. The unusual features, viz painful oedema of whole of the extremity and arthritis observed in our case could be due to severe inflammatory reaction secondary to HZ infection because it started with HZ infection in the same limb and subsided with passage of time.

The lesions of HZ usually follow their natural course and healing of cutaneous lesions is some times followed by post herpetic neuralgia. To our knowledge the features of painful limb oedema with arthritic changes has not been reported earlier in relation to HZ.

The belief of the patient that chloroquine caused the improvement in her condition may be coincidental. It can not be said definitely whether chloroquine caused the relief in our patient or not, unless this drug is tried in some more similar cases. The condition in our case might have improved itself.

 
  References Top

1.Oxman MN. Varicella and Herpes Zoster. In: Dermatology in General Medicine (Fitzpatrick TB, Eisen AZ, Wolff, et al, eds), 2nd edn, New York . McGraw-Hill Book company, 1979; 1600-16.  Back to cited text no. 1    
2.Nigam P, Dayal SG. Paralysis of the limb Complicating herpes zoster. Ind J Dermatol Venereol Leprol 1978; 44 : 293 - 4.  Back to cited text no. 2    
3.Grant BD, Rowe CR. Motor paralysis of the extremities in herpes zoster. J Bone Joint Surg 1961; 43 : 885 - 96.  Back to cited text no. 3    
4.Derveanx L, Lacquet LM. Hemidiaphragmatic Paresis after cervical zoster. Thorax 1982; 37: 870-1.  Back to cited text no. 4    
5.McCrackin D. Herpes zoster with bladder involvement. Lancet 1977; 1 : 863 - 4.  Back to cited text no. 5    
6.Jellinek EH, Tulloch WS. Herpes zoster with dysfunction of bladder and anus. Lancet 1976; 2 : 1219 - 22.  Back to cited text no. 6  [PUBMED]  
7.Richmund W. The genito-urinary manifestations of herpes zoster : Three case reports and a review of the literature. Br J Urol 1974; 46: 193-200.  Back to cited text no. 7    
8.Khare A K. Sacral herpes zoster and urinary retention. Ind J Dermatol Venereol Leprol 1986; 52: 184.  Back to cited text no. 8    


    Figures

[Figure - 1], [Figure - 2]



 

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