Varicella-Zoster-Mediated Radiculitis Reactivation following Cervical Spine Surgery: Case Report and Review of the Literature

Abstract

Varicella-zoster virus and herpes simplex virus types 1 and 2 are neurotropic viruses that can be reactivated after a surgical or stressful intervention. Although such cases are uncommon, consequences can be debilitating, and variable treatment responses merit consideration. We describe a 41-year-old male with a history of varicella-mediated skin eruptions, who presented with continuing right arm pain, burning, and numbness in a C6 dermatomal distribution following a C5-6 anterior cervical discectomy and fusion and epidural steroid injections. The operative course was uncomplicated and he was discharged home on postoperative day 1. Approximately ten days after surgery, the patient presented to the emergency department complaining of severe pain in his right upper extremity and a vesicular rash from his elbow to his second digit. He was started on Acyclovir and discharged home. On outpatient follow-up, his rash had resolved though his pain continued. The patient was started on a neuromodulating agent for chronic pain. This case adds to the limited literature regarding this rare complication, brings attention to the symptoms for proper diagnosis and treatment, and emphasizes the importance of prompt antiviral therapy. We suggest adding a neuromodulating agent to prevent long-term sequelae and resolve acute symptoms.

Resistant Pathogens, Fungi, and Viruses

“…Similarly there are very few data for VZV/HHV3 and HHV6-8 during critical illness. VZV has been reported following spinal surgery but otherwise remains understudied in critically ill patients (81, 144–147). As with other HHV, aberrations in cell-mediated immunity are thought to be one of the causes of VZV reactivation (148, 149).…”

<p>A Rare Case with New Insights: Pure Sensory Guillain Barre Syndrome with Axonal Features</p>

“…They usually present unilaterally and affect a single or very few levels, manifesting as dermatomal pain and vesicular eruption (post-herpetic neuralgia) years after the primary infection and therefore unlikely to be related to our patient's presentation. 27,28 Also, radiculitis may be associated with weakness unlike our case. 29 Finally, as stated above, the denervation potentials seen on follow up EMG indicate subclinical involvement of motor axons, therefore they exclude sensory neuronopathy.…”

Prophylaxis and treatment of acute and chronic postherpetic neuralgia

“…W wielu badaniach klinicznych wykazano skuteczność nortryptyliny i amitryptyliny [17]. Ponadto istnieją doniesienia, że środki neuromodulujące, takie jak gabapentyna, zapobiegają lub zmniejszają nasilenie nerwobólu związanego z HZ [27]. Zdaniem Drazin i wsp.…”

“…Zdaniem Drazin i wsp. [27] wcześnie rozpoczę-te leczenie przeciwwirusowe w połączeniu z lekami neuromodulującymi (nortryptylina) złagodziło ostre objawy i zapobiegło długotrwałym następstwom infekcji VZV po zabiegu neurochirurgicznym u 41-letniego pacjenta.…”