Postoperative abdominal herpes zoster complicated by intestinal obstruction:A case report

BACKGROUND Intestinal obstruction is a common occurrence in clinical practice.However,the occurrence of herpes zoster complicated by intestinal obstruction after abdominal surgery is exceedingly rare.In the diagnostic and treatment process,clinicians consider it crucial to identify the primary causes of its occurrence to ensure effective treatment and avoiding misdiagnosis.CASE SUMMARY Herein,we present the case of a 40-year-old female patient with intestinal obstruction who underwent laparoscopic appendectomy and developed herpes zoster after surgery.Combining the patient's clinical manifestations and relevant laboratory tests,it was suggested that the varicella zoster virus reactivated during the latent period after abdominal surgery,causing herpes zoster.Subsequently,the herpes virus invaded the visceral nerve fibers,causing gastrointestinal dysfunction and loss of intestinal peristalsis,which eventually led to intestinal obstruction.The patient was successfully treated through conservative treatment and antiviral therapy and subsequently discharged from the hospital.CONCLUSION Pseudo-intestinal obstruction secondary to herpes zoster infection is difficult to distinguish from mechanical intestinal obstruction owing to various causes.In cases of inexplicable intestinal obstructions,considering the possibility of a viral infection is essential to minimize misdiagnosis and missed diagnoses。

Autoimmune complications and clinical outcomes of herpes simplex encephalitis in children: A case series

Objective:To report the neurologic prognosis and autoimmune complications of 16 cases of childhood herpes simplex virus encephalitis.Methods:The study was conducted atŞanlıurfa Training and Research Hospital,Turkey from June 2017 to August 2019.The study included 16 pediatric patients aged between 6 months and 17 years(median age 77.7 months)who were diagnosed with herpes simplex virus type 1 encephalitis by pediatric infectious disease and pediatric neurology clinics.Patients were followed using patient records,and interviews at the pediatric neurology clinic or via the telephone.Clinical and demographic data,received therapies,neurologic prognosis and complications were evaluated.Results:Patients with and without autoimmune encephalitis were compared in terms of age,sex,symptom duration before treatment,initial cerebrospinal fluid protein,glucose,red blood count and white blood count but no significant difference was found.Autoimmune complications were seen in four patients.N-methyl-D-aspartate encephalitis was observed in three patients and choreoathetosis was seen in one patient.The average follow-up period was 48.3 months.Twenty-five percent of the patients were receiving multiple antiepileptic drug(AED)treatment,43.8%were receiving single AED treatment and 31.3%were not receiving AED treatment at the end of the follow-up.Motor disability was observed in 12.5%and drug-resistant epilepsy was observed in 6.3%who had autoimmune complications.Conclusions:Seizures and movement disorders were controlled with immunotherapy and autoantibodies should be studied routinely.Treatment should be started early upon recognition of autoimmune complications through follow-up by measuring autoantibody levels and clinical examination results.Effective prevention and curative treatment modalities are needed to avoid herpes simplex virus encephalitis complications.

Superior laryngeal nerve block for treatment of throat pain and cough following laryngeal herpes zoster:A case report

BACKGROUND Herpes zoster is caused by reactivation of latent varicella-zoster virus infection within the sensory nerve ganglion of the spinal or cranial nerves.Laryngeal herpes zoster is rare and involves superior laryngeal nerve,which leads to several complications such as throat pain,and cough.CASE SUMMARY Patient concerns:A 52-year old woman presented with a 70 d history of throat pain and a 67 d history of non-productive cough.Three days after onset of pain,she was diagnosed with laryngeal herpes zoster.Flexible nasolaryngoscopy revealed multiple white ulcerated lesions on the left hemi epiglottis and the left supraglottic area.She was prescribed with 750 mg famciclovir a day for 7 d,and 150 mg pregabalin,100 mg tramadol and 10 mg nortriptyline a day for 67 d.However,despite of these medications,she complained of pain and persistent cough.Therefore,superior laryngeal nerve block under ultrasound guidance was performed.Three days after the intervention,the throat pain and cough disappeared.The patient remained symptom-free at 3 mo follow-up.CONCLUSION A superior laryngeal nerve block can be an effective option for treatment of pain and cough following laryngeal herpes zoster.

Transverse myelitis caused by herpes zoster following COVID-19 vaccination:A case report

BACKGROUND Transverse myelitis(TM)is characterized by sudden lower extremity progressive weakness and sensory impairment,and most patients have a history of advanced viral infection symptoms.A variety of disorders can cause TM in association with viral or nonviral infection,vascular,neoplasia,collagen vascular,and iatrogenic,such as vaccination.Vaccination has become common through the global implementation against coronavirus disease 2019(COVID-19)and reported complications like herpes zoster(HZ)activation has increased.CASE SUMMARY This is a 68-year-old woman who developed multiple pustules and scabs at the T6-T9 dermatome site 1 wk after vaccination with the COVID-19 vaccine(Oxford/AstraZeneca([ChAdOx1S{recombinant}]).The patient had a paraplegia aggravation 3 wk after HZ symptoms started.Spinal magnetic resonance imaging(MRI)showed transverse myelitis at the T6–T9 Level.Treatment was acyclovir with steroids combined with physical therapy.Her neurological function was slowly restored by Day 17.CONCLUSION HZ developed after COVID-19 vaccination,which may lead to more severe complications.Therefore,HZ treatment itself should not be delayed.If neurological complications worsen after appropriate management,an immediate diagnostic procedure,such as magnetic resonance imaging and laboratory tests,will start and should treat the neurological complications.

Value of Chuanjin Qinggan decoction in improving the depressive state of patients with herpes zoster combined with depression

BACKGROUND Western medicine is beneficial for the recovery of neurological function in patients with depression,but some patients experience side effects such as headaches,dizziness,nausea,gastrointestinal symptoms,insomnia,and cardiac dysfunction.In recent years,integrative medicine has achieved positive results in the treatment of various diseases.AIM To study Chuanjin Qinggan decoction combined with selective serotonin reuptake inhibitors(SSRIs)in patients with herpes zoster complicated by depression.METHODS Patients with herpes zoster complicated by depression who were treated at the Yantai Hospital of Traditional Chinese Medicine from January 2021 to December 2022 were retrospectively selected as research participants.Among them,43 patients with herpes zoster complicated by depression who received SSRI treatment between January and December 2021 were assigned to the Western medicine group,while those who received combined treatment of traditional Chinese and Western medicine between January and December 2022 were assigned to the combined group.Both groups were treated for eight weeks.The degree of pain,effect of herpes zoster treatment,degree of improvement in depressive symptoms,serum neurotransmitter levels,sleep quality,and occurrence of adverse reactions were compared between the two groups.RESULTS We found that after eight weeks of drug treatment,the two treatment schemes achieved differing efficacy.In further comparison,we found that,compared with patients treated with SSRIs alone,patients treated with Chuanjin Qinggan decoction combined with SSRIs showed more significant improvement in depression and a greater increase in dopamine and 5-hydroxytryptamine levels after treatment(P<0.05).Patients treated with Chuanjin Qinggan decoction combined with SSRIs also experienced lower pain,better treatment efficacy for herpes zoster,better sleep quality,and a lower incidence of adverse reactions compared to those treated with SSRIs alone(P<0.05).All minor adverse reactions occurring during treatment were resolved after symptomatic treatment.CONCLUSION The treatment scheme of Chuanjin Qinggan decoction combined with SSRIs can improve the psychological state of patients with herpes zoster complicated by depression and alleviate adverse reactions.

Clinical Observation on Therapeutic Effect of Ji De Sheng She Yao Tablet on 16 Cases with AIDS Complicated by Herpes Zoster

The Ji De Sheng She Yao tablet (季德胜蛇药片）is a drug for snake-bites and insect bites. According to recent reports, this drug has been used to treat herpes zoster, hepatitis B, parotitis, nephrotic syndrome, acute conjunctivitis, recurrent aphtha, urticaria, etc.1 with good therapeutic effects. More than half of the AIDS patients suffered from herpes zoster. The area of skin lesion in AIDS patients is larger than that of the patients without AIDS and the pain lasts longer. Many cases have keloids and depigmentation for months, even severe pain till their death. Routine therapeutic methods are not satisfactory in therapeutic effects. The expert group of traditional Chinese medicine for cooperative research on AIDS used Ji De Sheng She Yao tablets (季德胜蛇药片) to treat AIDS complicated by herpes zoster for the first time and the results are reported as follows.

Acute pancreatitis associated with herpes zoster:Case report and literature review

Varicella-zoster virus(VZV)is a type of herpes virus known to cause varicella,mainly in young children,and herpes zoster in adults.Although generally non-lethal,VZV infection can be associated with serious complications,particularly in adults.Acute pancreatitis caused by VZV infection is a rare event,with reports primarily concerning immunocompromised individuals.Here we report a 44-year-old immunocompetent female who developed acute pancreatitis associated with VZV infection.The patient presented with vomiting and persistent pain in the upper quadrant less than one week after diagnosis and treatment for a herpes zoster-related rash with stabbing pain on the abdomen and dorsal right trunk side.A diagnosis of acute pancreatitis was confirmed based on abdominal pain,elevated levels of urine and serum amylase,and findings of peri-pancreatic exudation and effusions by computed tomography and magnetic resonance cholangiopancreatography.This case highlights that,though rare,acute pancreatitis should be considered in VZV patients who complain of abdominal pain,especially in the epigastric area.Early detection and proper treatment are needed to prevent the condition from deteriorating further and to minimize mortality.

Varicella zoster virus vaccines: potential complications and possible improvements

Varicella zoster virus(VZV) is the causative agent of varicella(chicken pox) and herpes zoster(shingles). After primary infection, the virus remains latent in sensory ganglia, and reactivates upon weakening of the cellular immune system due to various conditions, erupting from sensory neurons and infecting the corresponding skin tissue. The current varicella vaccine(v-Oka) is highly attenuated in the skin, yet retains its neurovirulence and may reactivate and damage sensory neurons. The reactivation is sometimes associated with postherpetic neuralgia(PHN), a severe pain along the affected sensory nerves that can linger for years, even after the herpetic rash resolves. In addition to the older population that develops a secondary infection resulting in herpes zoster, childhood breakthrough herpes zoster affects a small population of vaccinated children. There is a great need for a neuro-attenuated vaccine that would prevent not only the varicella manifestation, but, more importantly, any establishment of latency, and therefore herpes zoster. The development of a genetically-defined live-attenuated VZV vaccine that prevents neuronal and latent infection, in addition to primary varicella, is imperative for eventual eradication of VZV, and, if fully understood, has vast implications for many related herpesviruses and other viruses with similar pathogenic mechanisms.

Intestinal pseudo-obstruction caused by herpes zoster:Case report and pathophysiology

Herpes zoster(HZ) infection occurs in approximately 10% to 30% of individuals. Visceral neuropathies secondary to HZ can cause cystitis and urinary retention. But colonic pseudo-obstruction can also occur. Peripheral neuropathy may reveal segmental motor paresis of either upper or lower limbs, the abdominal muscles or the diaphragm. We report the case of a 62-year-old male patient who presented with abdominal distention and cutaneous vesicular eruption on the left side of the abdominal wall. Plain X-rays and computed tomography scan showed distended small bowel. A diagnosis of intestinal pseudo-obstruction was made secondary to segmental paresis of the small intestine and visceral neuropathy. Conservative management was successful and the patient was discharged uneventfully. Intestinal pseudo-obstruction ought to be consideredwhen dealing with non-obstructive(adynamic) conditions of the digestive tract associated with HZ infection; since early recognition may help to avoid unnecessary surgery.

Complete recovery of herpes zoster radiculopathy based on electrodiagnostic study:A case report

BACKGROUND Herpes zoster is a painful infectious disease caused by the varicella zoster virus.Herpes zoster radiculopathy,which is a type of segmental zoster paresis,can complicate the disease and cause motor weakness.This complication should be considered when a patient with a rash complains of acute-onset motor weakness,and the diagnosis can be verified via electrodiagnostic study.CASE SUMMARY A 64-year-old female with a history of asthma presented to the emergency department with stabbing pain,an itching sensation,and a rash on the right anterior shoulder that had begun 5 d prior.Physical examination revealed multiple erythematous grouped vesicles in the right C4-5 and T1 dermatome regions.Because herpes zoster was suspected,the patient immediately received intravenous acyclovir.On the third hospital day,she complained of motor weakness in the right upper extremity.Magnetic resonance imaging of the cervical spine revealed mild intervertebral disc herniation at C4-C5 without evidence of nerve root compression.On the 12th hospital day,electrodiagnostic study revealed right cervical radiculopathy,mainly in the C5/6 roots.Six months later,monoparesis resolved,and follow-up electrodiagnostic study was normal.CONCLUSION This case emphasizes that clinicians should consider the possibility of postherpetic paresis,such as herpes zoster radiculopathy,and that electrodiagnostic study is useful for diagnosis and follow-up.

Trigeminal extracranial thermocoagulation along with patientcontrolled analgesia with esketamine for refractory postherpetic neuralgia after herpes zoster ophthalmicus:A case report

BACKGROUND Primary trigeminal neuralgia can achieve satisfactory results through clinical treatment and intervention.The pathogenesis of neuralgia caused by varicellazoster virus infection of the trigeminal nerve is more complex,and it is still difficult to relieve the pain in some patients simply by drug treatment or surgical intervention.CASE SUMMARY A 66-year-old woman was hospitalized with herpetic neuralgia after herpes zoster ophthalmicus(varicella-zoster virus infects the ophthalmic branch of the trigeminal nerve).On admission,the patient showed spontaneous,electric shocklike and acupuncture-like severe pain in the left frontal parietal region,and pain could be induced by touching the herpes area.The numerical rating scale(NRS)was 9.There was no significant pain relief after pulsed radiofrequency and thermocoagulation of the ophthalmic branch of the trigeminal nerve.Combined with patient-controlled intravenous analgesia(PCIA)with esketamine,neuralgia was significantly improved.The patient had no spontaneous pain or allodynia at discharge,and the NRS score decreased to 2 points.The results of follow-up 2 mo after discharge showed that the NRS score was≤3,and the Pittsburgh Sleep Quality Index score was 5 points.There were no adverse reactions.CONCLUSION Trigeminal extracranial thermocoagulation combined with esketamine PCIA may be a feasible method for the treatment of refractory herpetic neuralgia after herpes zoster ophthalmicus.

Rehabilitation of shoulder paresis caused by herpes zoster according to the International Classification of Functioning, Disability and Health A case report

We describe the case of a 73-year-old man with left shoulder paresis caused by a herpes zoster infection of the left C5 dermatomes. The patient had been affected by pain for 10 days, a skin rash on his left shoulder and back for 5 days, and weakness of his left shoulder for 2 days before admission. Eiectromyography revealed denervation discharges from the left supraspinatus, infraspinatus and deltoid muscles, which was compatible with radiculopathy showing after zoster infection. The patient was examined in accordance with the International Classification of Functioning, Disability and Health, and treated with range-of-movement and strengthening exercises as well as activities of daily living and social participation. At 14 months after the onset of the condition, muscle strength had returned to normal. Electromyography revealed that motor unit action potentials were largely normal. These results indicate that the rehabilitation of paresis caused by herpes zoster can obtain positive results with suitable movement training.

A case report of abdominal distention caused by herpes zoster

Gastrointestinal complications caused by herpes zoster are extremely rare. Here, we described a case of abdominal distention caused by herpes zoster. The patient was a 59-year-old female who suffered from unexplained paroxysmal and a burning pain on the right part of her waist and abdomen, accompanied by abdominal distention. Intestinal pseudo-obstruction was diagnosed by abdominal radiography. Distention of the right abdominal wall was still apparent after one month. In this report, we found that recovery from abdominal distention caused by herpes zoster is difficult and may require surgical intervention.

Traditional Chinese medicine nursing protocols for herpes zoster

Herpes zoster is a viral infection caused by the reactivation of endogenous latent varicella zoster virus resulting in varicella,characterized by pain and vesicles in the restricted dermatomal distribution that occurs along the nerves w ith dormant virus. Postherpetic neuralgia( PHN) is the most common sequela of herpes zoster,occurs or persists after the rash has resolved. It is currently recognized that both herpes zoster and PHN have a substantial impact on the patients' quality of life and daily activities. In recent years,traditional Chinese medicine( TCM)has show n a certain effect in the treatment of herpes zoster. This article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of herpes zoster in order to further develop the advantages of TCM,improve its efficacy and standardize its nursing behavior.

Resolution of herpes zoster-induced small bowel pseudo-obstruction by epidural nerve block:A case report

BACKGROUND When herpes zoster is complicated with paralytic ileus,this mostly involves acute intestinal pseudo-obstruction of Ogilvie’s syndrome manifesting as obvious dilatation of the cecum and right colon;small intestinal obstruction is rare.Here,we present a patient with a very rare case of small bowel pseudo-obstruction.CASE SUMMARY A 76-year-old female patient complained of right upper quadrant pain.Two days later,a blistering,right-sided rash of the thoracoabdominal dermatome(T5-T10) emerged in conjunction with small intestinal dilatation and the inability to defecate.Computed tomography of the abdomen confirmed small bowel pseudoobstruction.Antiviral therapy,gastrointestinal decompression,and enemas proved unproductive.After 4 d of stagnation,an epidural block was performed for pain relief and prompted the passage of gas and stool,resolving the obstructive problem.Three days later,the rash appeared dry and crusted,and the pain diminished.After 5 d,no abnormality was visible by gastroenteroscopy,and the patient was discharged on day 7.CONCLUSION This case shows that herpes zoster may induce small bowel pseudo-obstruction in addition to colonic pseudo-obstruction.Epidural block can not only treat intercostal neuralgia but also resolve small bowel pseudo-obstruction caused by herpes zoster.

Elevated serum nitric oxide and hydrogen peroxide levels as potential valuable predictors of herpes zoster

Objective:To evaluate the biomarkers of oxidative stress in herpes zoster patients compared with control subjects.Methods:This study compared the nitric oxide(NO),hydrogen peroxide(H2 O2),malon dialdehyde,uric acid,and bilirubin levels between 43 herpes zoster patients and 47 age-matched control subjects.The area under the curve of the receiver operating characteristic curve was performed to evaluate the final logistic regression model.Results:The significant differences were observed in the serum levels of NO,H2 O2,and malondialdehyde between the case and the control groups(P<0.001).However,no statistical differences were found in both uricacid and bilirubin levels between the groups.Additionally,the raised oxidant biomarkers were strongly associated with increased disease severity(P<0.001).Multiple logistic regression analysis with the highest area under the curve[0.98(95%CI 0.95-1.00)]and the minimum number of variables showed that high levels of NO(OR 1.24;95%CI 1.06-1.46;P=0.008)and H2 O2(OR 1.25;95%CI 1.09-1.43;P=0.001)were associated with herpes zoster.Conclusions:High levels of NO and H2 O2 were observed in patients with herpes zoster.Increased NO and H2 O2 levels might be associated with herpes zoster,which needs to be confirmed by further studies.

A case of acute urinary retention after cesarean section caused by herpes zoster infection

We experienced a case of acute urinary retention after an elective cesarean section. In this case, an epidural catheter was inserted for the postoperative pain relief, and we had to rule out anesthetic complications including epidural hematoma. After careful investigation, sacral herpes zoster was found to be responsible for urinary retention. Early administration of antiviral agent was started and the outcome was good. As various factors may lead to postpartum urinary disorders, we should be careful not to miss serious complications.

Surrounding Needling with Fire Needle and Filiform Needle Plus Moxibustion in the Treatment of Lower Limb Herpes Zoster:One Case Report

Introduction Herpes zoster is a skin disease caused by activation of the varicella zoster virus,which is latent in neurons.It can be accompanied by severe neuralgia.Some herpes zoster patients may have pain allergy,general discomfort,loss of appetite and other prodromal symptoms,typical clinical manifestation as a cluster of blisters distribution along unilateral peripheral nerve,often accompanied by obvious neuralgia[1].

TREATMENT FOR SEQUELAE OF NEURALGIA AFTER THE HERPES ZOSTER WITH COMBINED ACUPUNCTURE AND INJECTION

The author treated 16 cases of sequelae of neuralgia after herpes zoster withacupuncture, moxibustion and point injection in the affected region, and all cases were cured.

COMPARATIVE OBSERVATION ON THE CURATIVE EFFECTS OF HERPES ZOSTER TREATED BY THE TYPE JI HE-NE LASER AND POLYINOSINIC ACID

Sixty-five cases of herpes zoster were randomly divided into the He-Ne laser group(33 cases) and polyinosinic acid group (32 cases). Type JI He-Ne laser universal treatment apparatuswas used to irradiate injured cutaneous regions and to radiate Hegu (LI 4) and Zusanli (ST 36) pointswith photoconductive fibers once every day in the He-Ne laser group; 2 ml of polyinosinic acid was in-tramuscularly injected once every other day in the other group. Of the 65 cases 63 were cured, andthe two cases with sequela of neuralgia were all in the latter group. Pain was disappeared and scabswere formed respectively after 1. 48 and 5. 76 days of treatment with He-Ne laser therapy, and after10. 5 and 10. 4 days with polyinosinic acid treatment. The differences of therapeutic effects betweenthe two groups were noticeably significant (P【0. 01 ).