Myelopathy after herpes zoster

A 73-year-old woman with a remote history of carcinoma of the ovary had herpes zoster involving several lumbosacral dermatomes. There subsequently developed a progressive myelopathy with normal myelographic findings and CSF pleocytosis. Vidarabine (15 mg/kg/day) was given for ten days. No further progression occurred. The syndrome of progressive myelopathy following herpes zoster is rare; direct viral invasion of the cord with subsequent necrosis appears to be the pathogenic mechanism. Antiviral therapy may have halted progression, but it did not lead to recovery of function.