Zoster sine herpete with thoracic motor paralysis temporally associated with thoracic epidural steroid injection.

Abstract

Reactivation of latent varicella-zoster virus can occur when the immune system is weakened leading to the typical presentation seen with herpes zoster or shingles. In a small percentage of these patients, motor paralysis can be seen in the affected myotomal distribution. Zoster sine herpete, or shingles without the typical vesicular rash, is an uncommon variant of zoster. Systemic steroids are known to weaken the immune response. Two previous case reports have implicated epidural steroid injections as a precipitating cause of zoster. We present a case of serologically verified zoster sine herpete producing an abdominal wall bulge, which occurred 1 wk after thoracic epidural steroid injection. Electromyography documented the presence of abdominal wall denervation. Given the low incidence of serologically proven zoster sine herpete--especially with thoracic motor paralysis--and the equally rarely documented incidence of zoster related to epidural steroids, we present what we believe to be the first reported case of zoster sine herpete with a neuropathic abdominal wall bulge occurring in close temporal association to receiving epidural steroids.