valacyclovir and Radiculopathy

Herpes zoster frequently causes dermatomal vesicular rash accompanied by severe neuralgia, and reaching a differential diagnosis may be challenging before the appearance of the vesicular rash.. A 40-year-old male patient visited the emergency department with a complaint of sudden onset motor weakness and ipsilateral radiating neuralgia to the Lt. thigh. He had suffered from chickenpox during childhood.. No skin lesion was present at the initial visit. The reverse Straight Leg Raise test was negative. Magnetic resonance imaging showed asymmetrically swollen dorsal root ganglion with Gadolinium enhancement. The vesicular rash that appeared on the sixth day after the symptom onset led to the diagnosis of herpes zoster.. Antiviral agent of valacyclovir (1000 mg t.i.d.) was administered for 7 days.. The patient recovered from motor weaknesses by 2 weeks from the onset of the symptom. Mild degree post-herpetic neuralgia recovered by 2 months.. A high index of suspicion is necessary to differentiate early herpes zoster radiculitis before the appearance of vesicular rash from compressive radiculopathy. In L2-3 ipsilateral radiating pain along the dermatome or myotome, the absence of reverse Straight Leg Raise sign may be a possible factor in differentiating herpes zoster radiculitis from compressive radiculopathy.

Topics: Adult; Antiviral Agents; Contrast Media; Gadolinium; Herpes Zoster; Humans; Lumbosacral Region; Magnetic Resonance Imaging; Male; Paresis; Radiculopathy; Republic of Korea; Valacyclovir

Whereas valacyclovir is widely used and is recommended by some authors in moderately immunocompromised HIV-infected patients, its use has not been validated by clinical studies. We report a case of herpes zoster in an HIV-infected patient for whom neurologic complication was not avoided despite valacyclovir therapy. Clinical outcome was favorable after intravenous acyclovir. This case suggests careful monitoring of valacyclovir in HIV-infected patients is necessary.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; CD4 Lymphocyte Count; Drug Monitoring; Electromyography; Herpes Zoster; Humans; Immunocompromised Host; Infusions, Intravenous; Male; Middle Aged; Patient Selection; Radiculopathy; Treatment Failure; Valacyclovir; Valine; Viral Load