초록접수[미리보기]

21KF-031
Herpes zoster myelitis, with occurrence of unusual neurologic symptoms in herpes zoster infection: case report
Kwang Uck Moon, Young Eun Moon, Ji Yeong Kim, So Young Lee, Jia Kim, Min A Joo, Hue Jung Park
Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Herpes zoster infection can cause a variety of neurologic complications. One of its serious complications is myelitis, which
is focal inflammation of the spinal cord, resulting in sensory and motor deficits in the corresponding region of the body. This condition is not easy to diagnose and can cause fatal complications if treatment is delayed. We report the successful treatment with myelitis of the cervical and sacral spine during acute herpes zoster infection with antiviral agents, continuousepidural block, and steroid pulse therapy

A 56-year-old female visited our pain center complaining of severe right buttock pain. All vesicles were observed within the right S3,4 dermatomes that had appeared four days prior. She was prescribed with famciclovir and caudal block was performed. Because of the persistent pain, a continuous epidural catheter was inserted at the S3 level. After confirming a decrease in pain, the catheter was removed. However, after two days, she complained of
urinary/fecal incontinence and weakness in her right lower limb. Lumbar MRI revealed diffuse leptomeningeal and dural
nhancement, with clumping of the cauda equina, representing arachnoiditis. The laboratory result was positive for serum VZV IgM/IgG and negative for cerebrospinal fluid VZV DNA by polymerase chain reaction. She was treated with steroid pulse therapy, iv acyclovir, and nerve block. After three month, symptoms were improved to the pre-illness level.

VZV myelitis is an unusual inflammation of the spinal cord that occurs during or following HZ. Early diagnosis may be difficult. MRI T2-weighted imaging shows the typical increased intramedullary signal intensity and swelling. The detection of VZV in CSF can also aid in the diagnosis. However, there have been many cases in which VZV has not been detected in CSF.
The optimal treatment has not yet been established. Some studies have reported that high doses of steroids and antiviral agents are helpful for recovery from myelitis. In cases in which continuous epidural block has been performed for acute HZ, the treatment duration and PHN frequency have been reported to be decreased. In patients with HZ, the possibility of myelitis should always be considered, because delay of the treatment can increase the risk of fatal neurologic complications.