| 제목 |
Abdominal Wall Pseudohernia due to Herpes Zoster : Case-report |
| 소속 |
National Health Insurance Service Ilsan Hospital, Department of Physical Medicine and Rehabilitation1, Severance Hospital, Department of Rehabilitation Medicine2 |
| 저자 |
Ha Ra Jeon1†, Hyeon Su Kim2*, Seong Woo Kim1, Da Wa Jung1, Jun Min Cha1 |
Introduction : Herpes zoster is a clinical syndrome caused by reactivation of a varicella-zoster virus (VZV) and it is characterized by the cutaneous distribution of rash and vesicles in the affected dermatomes. Sensory symptoms such as neuropathic pain and hypoesthesia are often accompanied in the affected dermatomes. Motor segmental paralysis is not common complication, but it can also occur in about 0.5% to 5.0% of patients with herpes zoster. Low-thoracic levels paresis in herpes zoster causes abdominal muscle weakness, which can lead to the abdominal wall protrusions or pseudoherniation. There has been few reports on herpes zoster induced abdominal pseudohernia. Here we present a case of abdominal wall pseudohernia caused by thoracic herpes zoster and neurophysiologic findings.
Case : A 62-year-old man visited the Physical Medicine and Rehabilitation outpatient clinic with complaint of right abdominal wall protrusion. Four weeks prior to visit the Physical Medicine and Rehabilitation clinic, he visited department of Family Medicine with complaint of characteristic herpetic rash and hyperesthesia at T10-12 dermatomes on right side. He diagnosed with herpetic zoster and took priscribed medicine. One week after the onset of the rash and pain, he noticed an abdominal wall protrusion in the area of the herpetic rash. Abdominal ultrasound, spine magnetic resonance imaging (MRI), needle electromyography (EMG) test, and dermatomal somatosensory evoked potential (SEP) were performed. There were no abnormal findings in abdominal ultrasound and MRI. In EMG studies, there were abnormal spontaneous activities in the right paraspinal muscles of T10-T12 levels, rectus abdominis and external oblique muscles. Dermatomal SEP studies showed prolonged latency of right T10 and T12 dermatomes.
Conclusion : Segmental motor weakness presenting with abdominal wall pseudohernia is a rare complication of herpes zoster. It is important to recognize such complication to avoid unnesseccary procedure or surgery because it is reversible and has good prognosis. Electromyography and dermatomal SEP are useful tool to evaluate clinical status and localize neurogenic lesion. |
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