acyclovir and Low-Back-Pain

Hip pain and varicella infections are common diagnoses affecting children and adolescents. Hip pain in childhood can be a challenging presenting complaint for the pediatrician or orthopedic physician. The differential diagnosis is broad, and ranges from benign conditions, such as transient synovitis and muscle strains, to more serious infections or malignancies. Acute hip pain is usually referred to an orthopedic surgeon, and the principal concern is to distinguish infection of the hip joint or pelvis from an irritable hip or musculoskeletal pain. The Varicella-zoster virus, a member of the herpes virus family, often presents as a generalized, pruritic, vesicular rash. The primary infection is commonly known as chickenpox. The prevalence of varicella infections has decreased significantly over the past decade with use of the varicella vaccine. Reactivation of varicella infection, or herpes zoster, in patients younger than 20 years is seen in only 68 per 100,000 people. Hip pain as the presenting symptom for onset of a herpes zoster infection is rare. This article presents a case of herpes zoster infection with initial presentation of hip pain in a 13-year-old boy. This case highlights the difficulty in diagnosing atraumatic joint pain in the pediatric population. The clinical importance of a thoughtful differential diagnosis, and the necessity of close follow-up by a pediatrician and/or orthopedic surgeon until there is a confirmed diagnosis cannot be overstated.

Topics: Acyclovir; Adolescent; Amines; Analgesics; Antiviral Agents; Cyclohexanecarboxylic Acids; Diagnosis, Differential; Gabapentin; gamma-Aminobutyric Acid; Herpes Zoster; Hip; Hip Joint; Humans; Low Back Pain; Male; Treatment Outcome

Two cases of recurrent lumbosacral herpes simplex without concomitant genital lesions are reported. Both patients presented with vesicular lesions on the middle of the lower back and on the left thigh, respectively, and had positive serum antibody to herpes simplex virus type 2 and negative antibody to HIV. The lesions healed completely within 1 week by oral administration of acyclovir.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Diagnosis, Differential; Enzyme-Linked Immunosorbent Assay; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Low Back Pain; Lumbosacral Region; Male; Recurrence; Unsafe Sex

To report a side effect of epidural corticosteroid injections for back pain.. Case series.. Review of clinical charts and photographs.. Private retina practice.. Two patients developed acute retinal necrosis syndrome following epidural corticosteroid injections for back pain. Referral was delayed in one patient. One patient developed bilateral secondary rhegmatogenous retinal detachment, and both developed secondary macular pucker.. Acute retinal necrosis can follow epidural corticosteroid injections. Patients should be warned about this possibility and advised to report should photopsias, photosensitivity, blurred vision, or new floaters develop after treatment. Orthopedists should be aware of the complication and promptly refer patients with symptoms for dilated fundus examination by an ophthalmologist.

Topics: Acyclovir; Aged; Antibodies, Viral; Antiviral Agents; Eye Infections, Viral; Female; Glucocorticoids; Herpes Simplex; Herpes Zoster Ophthalmicus; Herpesvirus 1, Human; Herpesvirus 2, Human; Herpesvirus 3, Human; Humans; Immunoglobulin G; Injections, Epidural; Low Back Pain; Male; Retinal Detachment; Retinal Necrosis Syndrome, Acute; Virus Activation