Abstract Details

Title Herpes Zoster Associated Myelitis: Clinical and Radiographic Features

Topic Infectious Disease

Presentation(s) P1 - Poster Session 1 (9:00 AM-5:00 PM)

Poster/Presentation
Number 232

Objective To report the clinical and radiological features of herpes zoster (HZ) associated myelitis.

Background

Myelitis is an uncommon complication of HZ, with considerable associated morbidity.

Design/Methods Cases of HZ associated myelitis presenting to Mayo Clinic Rochester between July 1, 1998, and June 30, 2018, were identified and retrospectively reviewed.

Results

Seventeen HZ associated myelitis patients were identified (7 female). Mean age at diagnosis was 58.8 years (range: 36-82). Ten patients were immunosuppressed including nine with underlying immunosuppressive conditions and six receiving immunosuppressive drugs.

A typical zoster rash was associated with myelitis in 16 patients and preceded the onset of TM symptoms in 11 patients (median 5 days; range 3-10). Clinical features included sensory dysfunction (n=13), motor dysfunction (n=12,) bladder dysfunction (n=8) and bowel dysfunction (n=4). Two patients also suffered meningoencephalitis.

MRI at presentation was abnormal in 10 of 13 cases. All had imaging abnormalities corresponding to the level of clinical rash. MRI abnormalities included cord contrast enhancement (n=9), nerve root enhancement and hypertrophy at the level of clinical rash (n=5) and a longitudinal extensive transverse myelitis pattern (n=4).

Thirteen patients were treated, all of whom received antivirals (10 initially IV and 3 oral then IV). In addition, 7 patients received adjunctive corticosteroids (5 IV methylprednisolone and 2 oral prednisone). Longitudinal data were available in 12 patients (median 12 months; range 2-36) and at last follow up four patients were normal, four had mild motor or sensory symptoms and two patients had severe weakness and disability.

Conclusions

Myelitis is a rare complication of HZ infection and may lead to significant disability. Radiological abnormalities often overlap with the location of zoster skin manifestations, and focal nerve root contrast enhancement or hypertrophy may be a diagnostic clue in cases of myelitis which precede rash onset.

Authors/Disclosures
James D. Triplett, MBBS (Concord Hospital) PRESENTER	Dr. Triplett has nothing to disclose.
Michel Toledano, MD (Mayo Clinic)	Dr. Toledano has nothing to disclose.
Lyell K. Jones, MD, FAAN (Mayo Clinic)	Dr. Jones has received personal compensation in the range of $100,000-$499,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. Dr. Jones has received publishing royalties from a publication relating to health care. Dr. Jones has received personal compensation in the range of $10,000-$49,999 for serving as a President-Elect with American Academy of Neurology. Dr. Jones has a non-compensated relationship as a member of the AAN Board of Directors with AAN that is relevant to AAN interests or activities. Dr. Jones has a non-compensated relationship as a Chair of the Mayo Clinic ACO Board of Directors with Mayo Clinic that is relevant to AAN interests or activities.