Elsberg Syndrome: An Overlooked But Treatable Cause of Back Pain

Elsberg syndrome is an uncommon cause of lumbosacral radiculitis that presents as a constellation of symptoms, including urinary retention, bowel incontinence, severe constipation, impotence, and saddle anesthesia.

A 32-year-old female presented to the emergency department with complaints of bilateral leg pain and urinary retention. Two weeks prior, she noticed new genital lesions and had a positive nucleic acid amplification test for herpes simplex virus (HSV) type 2. Magnetic resonance imaging of the lumbar spine showed extraforaminal enhancement and edema-like signal within all the lumbosacral nerve roots. Cerebrospinal fluid (CSF) studies, CSF culture, and meningitis panel were unremarkable.

Elsberg syndrome likely accounts for 5% to 15% of patients with cauda equina syndrome. However, physicians often leave out Elsberg syndrome in the differential diagnosis of acute cauda equina syndrome and do not perform HSV testing to facilitate definitive diagnosis. As a result, Elsberg syndrome is underreported.

A high degree of clinical suspicion should be deployed when diagnosing patients with bilateral lumbosacral radiculitis, as early detection and treatment of Elsberg syndrome prevents long-term morbidity.