Disseminated herpes zoster with cauda equina symptoms☆

Highlights • Herpes zoster results from the reactivation of dormant varicella zoster virus. • Risk factors include older ages and immunosuppression. • Lumbosacral plexopathy is a complication of disseminated herpes zoster. • Early treatment even in immunocompetent patients can decrease morbidity. • Awareness of the complications is crucial to provide early treatment.
Herpes zoster is a common infection resulting from the reactivation of dormant varicella zoster virus in a posterior dorsal root ganglion. The typical dermatomal involvement includes the thoracic region, followed by the face and the cervical and lumbosacral regions, with 1% having disseminated disease. We present a rare case of an immunocompetent 85-year-old man presenting with herpes zoster at the L3-S2 dermatomes, that evolved to disseminated varicella zoster virus (dVZV), with radiologically and laboratory-confirmed lumbosacral plexopathy manifesting with cauda equina syndrome. Here we also discuss the diagnosis and complications of dVZV as well as treatment strategy. By maintaining a high degree of clinical suspicion and initiating early treatment, high-quality patient care and good outcomes are able to be achieved in cases like this.