Lumbar hernia following herpes zoster

S Baveja, YK Sharma, PR Rao

 Military Hospital Jabalpur Cantonment., (M.P) 482 001, India

Correspondence Address:
S Baveja
Military Hospital Jabalpur Cantonment., (M.P) 482 001
India

Introduction

Herpes zoster is primarily a disease of dorsal root ganglion of sensory nerves or extramedullary ganglion of cranial nerves. The occurrence of motor deficit varies from 0.5 to 31 percent and is more common in the elderly.[1] Lumbar hernia following weakness of the anterior abdominal wall affected by herpes zoster is extremely rare. In the present communication we document one such case.

Case Report

A 55-year-old patient presented with complaint of painful fluid filled rash on right side of abdomen and back of four days duration. Examination revealed multiple grouped tense vesicles on an erythematous base in right T 10 and 11 dermatome. On the seventh day of illness he developed constipation which was partially relieved with laxatives and three days thereafter noticed a diffuse swelling in the affected dermatome, which gradually increased in size over next two days and became static thereafter. Swelling was non tender, reducible and became prominent on straining [Figure - 1]. Abdominal wall movements on the affected side were reduced. He was diagnosed to have lumbar hernia which necessitated surgical repair [Figure - 2].

Discussion

Herpes zoster may rarely involve the motor neurones leading to paresis/paralysis of muscles supplied by the affected segment(s). Motor affection of facial nerve is the commonest. Less commonly paralysis of ocular muscles, trunk muscles, diaphragm, bladder and bowel may occur. To the best of our knowledge only one case of lumbar hernial has been reported following herpes zoster of T10, 11 dermatome.[2] In our case also hernia occurred following weakness of abdominal wall affected by herpes zoster. Despite successful repair of the hernia, chances of recurrence are there due to residual weakness of the affected abdominal musculature.

1.	Weiss S, Striefer M, Weiser HS. Motor lesions in herpes zoster, Eur Neurol 1975; 13:332. [Google Scholar]
2.	Landthaler M, Heuser M. Paralytische Bauchwandhernie bei Zoster. Hautarzt 1979; 30:432. [Google Scholar]