Disclosures: Yashesh A. Parekh: Nothing to disclose

Case Description: The patient was referred to the clinic for right lower extremity weakness. Initial symptoms began 4 months ago with acute onset right-sided lower back pain radiating down her right lateral thigh followed by painful vesicles and numbness in the same dermatomal distribution. Physical exam demonstrated weakness of her right hip flexor, knee extensor muscles, and ankle dorsiflexion.

Setting: Outpatient rehabilitation clinic.

Patient: A 66-year-old female with a history of lumbar spondylosis with herpes zoster induced right sided  L2-L5 radiculoplexopathy.

Assessment/Results: MRI showed mild degenerative changes of the spine. These findings were consistent with pre-existing lumbar spondylosis and not associated with the new symptoms. Subsequently, electromyography was done showing fibrillation and positive sharp waves in upper to lower paraspinal muscles, tensor fascia lata, quadriceps, iliopsoas, tibialis anterior, medial gastrocnemius, and peroneus longus. These findings were suggestive of lumbosacral polyradiculoplexopathy involving the axonal motor segment at the L2-L5 level. Currently, the patient continues to gradually make progress with outpatient physical therapy.  

Discussion: Herpes zoster is a rare etiology of lumbosacral radiculoplexopathy that should be considered in patients who are over the age of 60, immunocompromised, or presenting with clinical manifestation of a herpes zoster infection. Although VZV reactivation generally manifests with infiltration of the sensory dorsal root ganglia, it can sometimes be associated with the lymphocytic infiltration of ventral roots along with proximal local neuritis of the spinal nerve.  The prognosis for herpes zoster induced radiculoplexopathy for otherwise healthy patients is generally excellent. Complete or partial recovery occurs in most patients in 1-2 years. The rehabilitation of these patients includes physical and occupation therapy progressing to strengthening exercises and functional mobility training to prevent disuse atrophy or somatic overuse pains.

Conclusion: Herpes zoster induced radiculoplexopathy can lead to month or years of functional impairment for vulnerable populations (i.e. elderly, immunocompromised). 

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/lumbosacral-polyradiculoplexopathy-after-herpes-zoster-infection-a-case-report/