Abstract

Herpes Zoster caused by varicella zoster virus is a rare but potential cause of motor weakness. Segmental zoster paresis is an exceptional complication of herpes zoster characterized by focal weakness that may not occur simultaneously with cutaneous manifestations. It can be easily misdiagnosed as neuro muscular or spinal disease. Motor nerves may be involved in 5 to 15% of cases affecting the muscles of extremities. Careful examination and electromyography studies show that the muscles are implicated in about 50% of the cases patients may land up in orthopaedic department, suggesting underlying spinal disease. We report a patient who was misdiagnosed as a case of ‘frozen shoulder’ with irritant contact dermatitis secondary to topical analgesic gel. MRI scan of spine was planned and simultaneously dermatological consultation was sought for contact dermatitis. It was a case of herpes zoster involving C4-T2 dermatomes of right side. Subsequently with in a period of one week she notices progressive weakness in abduction movements of right upper limb. Segmental zoster paresis is a rare complication, it should be considered in differential diagnosis of segmental pain and weakness of extremities especially in elderly and immunocompromised patients. Diagnosis as established on clinical feature and electromyography studies and MRI spine. Correct diagnosis avoids unnecessary surgical management and allows timely antiviral treatment to prevent post herpetic neuralgia.

Key Words: segmental paresis, herpes zoster, complications.

Dr Ghanshyam Verma

Dept. of Dermatology, Venereology and Leprosy

Indira Gandhi Medical College, Shimla, HP

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