Disclosures: Kaile Eison, DO: Nothing to disclose

Case Description: 62-year-old woman with primary progressive multiple sclerosis (MS) status post autologous stem cell transplant in 2016 with severe medical complications who presented to the hospital after developing a painful disseminated herpes zoster rash on her right thigh, perineum, and vulva, preventing her from being able to catheterize herself. Subsequently, she developed numbness and paresis of her right leg. MRI spine was consistent only with chronic changes related to MS. Lumbar puncture was significant for varicella zoster virus and she was diagnosed with Zoster associated limb paresis.

Setting: Inpatient Rehabilitation Unit

Patient: 62-year-old woman with primary progressive multiple sclerosis status post autologous stem cell transplant in 2016 with severe medical complications. Prior to this hospitalization, she used a wheelchair but was independent of transfers, could move all extremities antigravity, and self catheterized.

Assessment/Results: Zoster associated limb paresis leading to worsening immobility and functional impairment in a woman with primary progressive multiple sclerosis.

Discussion: Varicella zoster virus is a herpes viruses known to infect humans and can cause a dermatomal reaction that commonly affects elderly and immunocompromised patients. The infection usually involves the sensory nerves, though it can have much more complex neurologic involvement. Herpes zoster motor neuropathy, also known as Zoster l(ZALP), is a rare complication, with an estimated prevalence of 0.6%–5%. It is thought it occurs when the virus affects the anterior horn cell and is best diagnosed with electrodiagnostic studies. The prognosis is generally favorable, but it can lead to permanent disability.

Conclusion: ZALP is a rare complication of HZ. This case is made even more complex by the patient’s underlying diagnosis of multiple sclerosis. The combination of these two pathologies resulted in a devastating outcome for the patient, affecting her mobility, functional ability, and quality of life, and requiring ongoing rehabilitation in both an inpatient and outpatient setting.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/calling-zalp-a-case-of-varicella-zoster-motor-neuropathy-in-a-patient-with-primary-progressive-multiple-sclerosis/