Varicella zoster lumbosacral plexopathy: a rare cause of lower limb weakness

BMJ Case Rep, 2018 · DOI: 10.1136/bcr-2017-223947 · Published: May 30, 2018

Immunology Neurology Research Methodology & Design

Simple Explanation

This case report describes a rare instance of Varicella zoster virus (VZV) causing lumbosacral plexopathy, confirmed by radiology and lab tests. The report emphasizes the importance of considering VZV as a possible diagnosis when a patient shows progressive motor weakness along with a vesicular rash. The patient, an 84-year-old woman, experienced lower limb weakness and a rash, leading to the diagnosis and treatment for VZV lumbosacral plexopathy.

Study Duration

11-month follow-up

Participants

One 84-year-old woman

Evidence Level

Level 4: Case Report

Key Findings

1
Contrast-enhanced MRI revealed enhancement of the left L3–L5 descending nerves and left lumbosacral plexus, indicative of inflammatory/infectious aetiology.
2
Cerebrospinal fluid PCR confirmed VZV DNA, and serological testing was positive for VZV immunoglobulin IgM and IgG antibodies.
3
The patient experienced acute renal failure due to acyclovir-induced nephropathy during treatment, requiring dose adjustment.

Research Summary

This is a rare case of Varicella zoster virus (VZV) lumbosacral plexopathy in an 84-year-old women presenting with lower limb weakness and rash. After a prolonged course of oral acyclovir and inpatient rehabilitation, the patient made a partial neurological and functional recovery. The case highlights the importance of evaluating clinical features such as progressive proximal motor weakness in the presence of a vesicular dermatomal rash, in the formulation of VZV as a differential diagnosis.

Practical Implications

Diagnostic Awareness

Clinicians should consider VZV lumbosacral plexopathy in patients presenting with lower limb weakness and dermatomal rash.

Early Imaging

Early MRI can help exclude other causes of neurological symptoms, such as spinal cord compression.

Treatment Monitoring

Careful monitoring of renal function is essential during acyclovir treatment to prevent acyclovir-induced nephropathy.

Varicella zoster lumbosacral plexopathy: a rare cause of lower limb weakness

Simple Explanation

Key Findings

Research Summary

Practical Implications

Diagnostic Awareness

Early Imaging

Treatment Monitoring

Study Limitations

Your Feedback

Was this summary helpful?

Varicella zoster lumbosacral plexopathy: a rare cause of lower limb weakness

Simple Explanation

Key Findings

Research Summary

Practical Implications

Diagnostic Awareness

Early Imaging

Treatment Monitoring

Study Limitations

Your Feedback

Was this summary helpful?