Editor-in-Chief: Alaa Abd-Elsayed, MD, PhD
BACKGROUND: The vesicular eruptions presented in a given herpes zoster case are considered a classic hallmark symptom amongst medical professionals and their patients. However, a case of herpes zoster could present with atypical symptoms seldomly acknowledged, such as motor complications. One remarkable motor complication is that of a pseudohernia, which could present as either a painful or painless bulge in the lower abdominal region. We herein report a case of herpes zoster virus presenting with abdominal muscle paralysis and pseudohernia, which uniquely resolved within 6 days following a single epidural treatment.
CASE REPORT: The patient is a 66-year-old White man who presented to the pain management clinic with transverse abdominis muscle paralysis, and an apparent mass of unknown origin following a recent outbreak of herpes zoster virus 10 days prior. He was treated with acyclovir when first diagnosed with herpes zoster virus, which helped with the cutaneous eruptions. The patient’s unknown mass failed to recede following antiviral treatment. This mass was visually apparent and palpable. The mass was soft and irregular in shape. It moved upon palpation and would get more prominent with standing and the Valsalva maneuver. The mass was generally painless, except when performing the Valsalva maneuver. Our patient had a computed tomography scan that ruled out the possibility of the mass being a herniation. After ruling out other differential diagnoses, it was determined our patient’s mass was that of a pseudohernia, a rare but documented complication of herpes zoster virus. Our patient was given an epidural steroid injection that consisted of dexamethasone, bupivacaine 0.25%, and saline for the pain from the cutaneous scarring. Our patient had 50% resolution of his transverse abdominis muscles later that same day. Within a week, our patient had complete resolution of his abdominal muscles and the mass was gone.
CONCLUSION: The use of an interlaminar epidural injection consisting of dexamethasone, bupivacaine 0.25%, and saline has not been reported as a possible treatment for pseudohernia. It is necessary for physicians to be aware of the complication known as pseudohernia secondary to herpes zoster virus, as well as the possibility of its treatment with this epidural injection.
KEY WORDS: Epidural injection, herpes zoster virus, pseudohernia, shingles