Abstract Details

 We have shown that approximately one-third of LRPN cases have a trigger. The most common triggers are surgery, rapid glycemic changes, vaccines, and infection. Varicella-zoster virus (VZV) is known to cause central and peripheral nervous system complications but the association of VZV and LRPN has not been systematically studied.

To describe an association between herpes zoster and lumbosacral radiculoplexus neuropathy (LRPN).

We performed an electronic chart review to identify patients who developed LRPN up to 4 weeks after the appearance of VZV infection rash at our institution between 1/1/2000 to 12/31/2017.We only included patients who had classic herpes zoster diagnosed by a physician.

Seven patents were identified. 5 (71%) had diabetes mellitus. Median age-at-onset was 68 years (range 48-76), 5 (71%) were female and median time to LRPN diagnosis was 6 (2-16) months.  Median time from rash onset to LRPN onset was 3 (1-4) weeks, and median time from LRPN onset to neuropathy nadir was 6 (2-12) months. The rash location was the trunk region in 3 (43%) patients, face in 2 (29%), groin in 1 (14%) and arm in 1 (14%). No patient had diffuse VZV infection. All patients had symptoms in nerve and root territories outside of the rash distribution. At diagnosis, 3 (43%) patients had more than 10 lbs. weight loss, 5 (71%) had bilateral lower extremity involvement, 3 (43%) had pan-plexus involvement, and the median mRS was 3(2-4). In 3 patients, herpes zoster preceded a recurrence of LRPN in patients with prior episodes of LRPN.

Herpes zoster can be associated with LRPN. Although VZV may directly cause peripheral nerve injury, the protracted worsening of LRPN, neuropathic symptoms and findings in nerve distribution beyond the rash location and recurrence of LRPN post-VZV suggests that VZV is acting as a trigger rather than a direct cause of LRPN.