Varicella-Zoster Radiculitis Mimicking Sciatica: A Diagnostic Dilemma

Area of Science:

• Neurology
• Infectious Diseases
• Dermatology

Background:

• Varicella-zoster virus (VZV) commonly causes thoracic radicular pain.
• Lumbar and thigh VZV presentations are less frequent but significant.

Observation:

• Two patients presented with back pain and leg radiculopathy, initially diagnosed as discogenic issues.
• Vesicular-bullous rash in a dermatomal distribution with pain and allodynia is characteristic of VZV.
• Pain often precedes the rash in VZV radiculitis.

Findings:

• VZV radiculitis can be misdiagnosed as prolapsed disc, leading to delayed or incorrect treatment.
• Rash was initially misattributed to external factors like hot fomentation in reported cases.
• The study highlights the importance of considering VZV in radicular pain differentials.

Implications:

• Emphasizes including varicella-zoster radiculitis in the differential diagnosis for radicular pain.
• Stresses the necessity of thorough physical examination, especially for rash assessment.
• Timely diagnosis of VZV can prevent unnecessary investigations and improve patient outcomes.