<p>Herpes Zoster and Postherpetic Neuralgia in an Elderly Patient with Critical COVID-19: A Case Report</p>

Abstract

Critical patients with COVID-19 are thought to be at high risk of developing chronic pain. However, the exact nature and mechanisms of COVID-19-related chronic pain remain largely unknown. Here, we describe clinical features, treatments and outcome of herpes zoster as well as postherpetic neuralgia in a 70-year-old woman with critical COVID-19. The patient had a history of type 2 diabetes and myasthenia gravis. She developed herpes zoster in the right 10 to 12 lumbar dermatomes in the recovery period of COVID-19. Intravenous (250 mg 3 times a day) and then oral (400 mg 5 times a day) acyclovir was used for antiviral therapy. Pregabalin (75 mg orally twice a day) and ibuprofen was used for analgesia. Her skin lesions resolved 21 days after the onset of rash. However, she continued to have persistent pain in the same dermatomal distribution. After the dosage of pregabalin was increased to 150 mg orally twice a day, her pain was partially relieved. During the telephone follow-up 4 months after herpes zoster eruption, the patient still complained intermittent pain in the right 10 to 12 lumbar dermatomes. Our case draws attention to postherpetic neuralgia in COVID-19 patients and provides a targeted suggestion for this kind of patients.

Can COVID-19 Increase the Risk of Herpes Zoster? A Narrative Review

“…There were two cases of multi-dermatomal involvement, and three cases had necrotic features in otherwise healthy individuals [ 5 , 17 ]. Postherpetic neuralgia (PHN) was reported in one case [ 11 ].…”

“…Lymphopenia (or relative lymphopenia) was reported in several cases, including those with (1) multi-dermatomal involvement, (2) necrotic features or (3) HZ occurring 8–10 weeks following COVID-19 diagnosis [ 5 , 11 , 16 , 17 ]. A low CD4 + /CD8 + ratio was reported in two cases and an increased interleukin (IL)-6 level in one case [ 5 , 17 ].…”

“…Demographic and Co-Morbid Conditions Cases included both genders and were reported worldwide, including Europe (Italy, Spain), Asia (Saudi Arabia, China, India), Africa (Egypt), North America (United States) and South America (Brazil) [6][7][8][9][10][11][12][13][14][15][16][17]. There were cases with known risk factors for HZ, which included age[ 50 years (n = 18), immunosuppressive therapies/immunomodulators (n = 2) and diabetes mellitus (n = 3) [5,7,8,10,11,[13][14][15][16][17].…”

“…Lymphopenia (or relative lymphopenia) was reported in several cases, including those with (1) multi-dermatomal involvement, (2) necrotic features or (3) HZ occurring 8-10 weeks following COVID-19 diagnosis [5,11,16,17]. A low CD4 ?…”

Rehabilitation and COVID-19: a rapid living systematic review 2020 by Cochrane Rehabilitation Field. Update as of September 30th, 2020

“…Due to the heterogeneity of published studies, a meta-analysis was not appropriate, thus the results are described qualitatively. Based on the OCEBM 2011 Levels of Evidence table 41 most studies (78.4%) were Level 4 (15 case reports 4,6,8,15,17,18,20,[23][24][25]27,28,34,39,40 , 7 case series 11,12,21,29,30,36,38 , and 7…”