From rash to spine: A rare case report of Herpes zoster myelitis

Herpes zoster myelitis is a rare but serious neurological condition. The present case emphasizes the importance of carefully inquiring about the patient's medical history and conducting a comprehensive physical assessment. Reports of such cases are valuable for raising awareness of herpes zoster complications, reducing misdiagnosis, and guiding clinical treatment.

A 45-year-old male patient presented with weakness in the left lower limb for more than 20 days, along with a herpetic rash and pain in the left lumbar and left abdominal regions. The patient reported a history of herpes development in June 2024.

The physical examination upon admission had shown weakness and hypesthesia in the left lower limb. Furthermore, laboratory tests had shown positive IgG antibodies against the varicella-zoster virus in the cerebrospinal fluid. Magnetic resonance imaging of the spinal cord had revealed hyperintense signals on T2-weighted images at the T7-T9 vertebral level. The final diagnosis was herpes zoster myelitis based on clinical and imaging findings.

The patient received acyclovir treatment and steroid pulse therapy, which resulted in partial improvement of symptoms.

The patient's muscle strength improved from 3/5 at admission to 4/5 at discharge; additionally, numbness has decreased, and pain and temperature sensations have improved.

The early recognition of rare diseases is paramount, which is not only benefits individual patients but also contributes to accumulating clinical knowledge that enhances collective diagnostic acumen in managing these challenging conditions.