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CASE REPORT
Year : 1994  |  Volume : 60  |  Issue : 2  |  Page : 97-98

Axillary nerve palsy following herpes zoster




Correspondence Address:
Rishi Bhargava


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Source of Support: None, Conflict of Interest: None


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  Abstract 

Herpes zoster causing axillary nerve palsy is quite rare. We are reporting a case of paresis of Deltoid muscle on the left side following Herpes zoster.


Keywords: Herpes Zoster, Deltoid Muscle, Paresis


How to cite this article:
Bhargava R, Agarwal U S, Narayan R. Axillary nerve palsy following herpes zoster. Indian J Dermatol Venereol Leprol 1994;60:97-8

How to cite this URL:
Bhargava R, Agarwal U S, Narayan R. Axillary nerve palsy following herpes zoster. Indian J Dermatol Venereol Leprol [serial online] 1994 [cited 2019 Dec 8];60:97-8. Available from: http://www.ijdvl.com/text.asp?1994/60/2/97/4005



  Introduction Top


Herpes Zoster (HZ) caused by varicella­zoster virus is subsequent to reactivation of latent infection in sensory ganglion and the virus lodges into sensory ganglion via continuous exteroceptive nerves or by haematogenous route during chicken pox irfection. [1] On reactivation it traverses through sensory nerve roots and produces clinical picture. Infection is usually limited to sensory ganglion and nerve roots but it may occasionally involve motor system leading to paresis of muscles supplied by the affected nerve segment. [2]

Axillary nerve is formed by posterior cord of branchial plexus (C S ,C 6 ) and supplies the deltoid muscle. Isolated axillary nerve involvement leading to paralysis of deltoid muscle is rare.


  Case Report Top


A 52-year-old man developed pain and multiple grouped vesiculobullous eruption on erythematous base over the outer aspect of left arm and forearm [Figure - 1]. Next morning he noticed inability to abduct his left arm. On examination of the left arm, upto first 15° of shoulder abduction could be carried out by the patient but not beyond it [Figure - 2]. Flexion and extension of arm and forearm, rotatory movement of shoulder were normal. Cutaneous sensory loss was present on lower half of the deltoid muscle. Systemic examination was normal. Patient was treated symptomatically for HZ. After the initial increase in the lesion, they gradually subsided in next 7-10 days. The lesions completely healed in 2 weeks. However, function of the deltoid muscle did not show any improvement.

After 3 months of follow up dropping and flattening of shoulder, reduction of the deltoid muscle mass and prominent acromion process were observed. There was no improvement in abduction of shoulder.


  Comments Top


Herpes zoster usually occurs in thoracic 53%, cervical (C 2 , C 3 , C 1 ) 20%, opthalmic division of trigeminal nerve 15% and lumbosacral 11% dermatomes of body. [3] Moschella [4] found most common involvement of C 2 & L 2 dermatomes. Motor system may be affected in the form of paresis of muscles. Pathy [5] had described 14 cases of herpes zoster leading to flaccid paralysis of limb muscles. Eban [6] described a case of deltoid muscle paresis after cervical herpes zoster and subsequent painful shoulder with marked subluxation of head of humerus. The present case had complete paralysis of isolated deltoid muscle with dropping and flattening of shoulder after 3 months of follow up, probably due to disuse atrophy. The cause of muscle paresis in herpes zoster is not clear. Two possible factors may be contributory (i) gangliomuscular disease subsequent to infection of propioceptive ganglion cells or (ii) myositis.' Schmidbauer [8]sub have demonstrated varice1la zoster virus in myositic masseter muscle of trigeminal herpes zoster. But myositis, even if it occurs with herpes zoster, causes muscle paralysis, is not clear.

 
  References Top

1.Gleb L D. Varicella - zoster virus. In : Virology (Fields BN. Knipe DM, eds), 2nd edn. New York : Raven Press, 1970; 2011-54.  Back to cited text no. 1    
2.Denny - Brown D, Adams R D, Fitzgerald,P J. Pathologic features of herpes zoster : a note on geniculate herpes. Arch Neurol Psychiatr 1944; 51 : 216-31.  Back to cited text no. 2    
3.Nagington J, Rook A, Highest AS. Virus and related infection : Varicella and zoster. In : Text book of Dermatology (Rook A, Wilkinson DS, Ebling FJG, et al eds), 4th edn. Bombay Oxford University Press, 1987; 680-5.  Back to cited text no. 3    
4.Burnett JW, Cruteher WA. Viral and Rickettsial infections : Herps zoster. In : Dermatology (Moschella SL, Hurley HJ, eds), 2nd edn. New Delhi : Jaypee brothers, 1985; 686-9.  Back to cited text no. 4    
5.Pathy. Motor complication of Herpes zoster. Age, Ageing 1979; 8 (2) : 75-80.  Back to cited text no. 5    
6.Eban R. Cervical herpes zoster and shoulder Pain. Br Med J 1978; 177 : 21.  Back to cited text no. 6    
7.Noris F H, Dramov B, Calder C D, Jhonson S G. Virus-like particles in myositis accompanying herpes zoster, Arch Neurol 1969; 21 : 25-31.  Back to cited text no. 7    
8.Schmidbauer M, Budka H, Pilz P, Kurata T, Hondo R. Presence, distribution and spread of productive varicella zoster virus infection in nervous tissue, Brain 1992; 115 : 383-98.  Back to cited text no. 8  [PUBMED]  


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[Figure - 1], [Figure - 2]



 

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