[A case of herpes zoster myelitis improved with acyclovir]

A case of herpes zoster myelitis improved with acyclovir was reported. A 71-year-old female showed a rash over the S2-4 dermatomes on the right side. After that, paraplegia and dysuria progressed. Patellar tendon reflex was exaggerated, but Achilles tendon reflex was normal. Babinski and Chaddock sign were bilaterally elicited. Superficial sense was markedly decreased below the Th12 dermatome. Vibration sense was slightly decreased but position sense was normal on the lower extremities. Cerebrospinal fluid analysis revealed pleocytosis, and an elevation of IgG and varicella-zoster virus antibody titer. Acyclovir (250 mg bid/day) was given for ten days. Paraplegia, sensory disturbance and dyschezia improved but dysuria did not. In this case acyclovir administration was started on the 18th day after the onset of myelopathy. Early initiation of acyclovir treatment might lead to recovery of dysuria. As the pathogenic mechanism of herpes zoster myelitis is considered to be direct viral invasion of the spinal cord with subsequent necrosis, early initiation of acyclovir treatment is necessary for the recovery.