Article Text

Download PDFPDF
Uncommon presentation and complications of herpes zoster infection involving the cervical, vagus and accessory nerves which caused a delay in diagnosis and treatment
  1. Ziqi Wang1,
  2. Thomas Lotina2 and
  3. John Malaty2
  1. 1University of Florida Health, Gainesville, Florida, USA
  2. 2Department of Community Health and Family Medicine, University of Florida Physicians Family Practice Medical Group, Gainesville, Florida, USA
  1. Correspondence to Dr John Malaty; malaty{at}ufl.edu

Abstract

A 70-year-old man with a history of invasive anal squamous cell carcinoma treated with excision and chemoradiation presented to the emergency department with right-sided neck pain and submandibular lymphadenopathy. CT imaging of the head and neck was unrevealing. The patient eventually developed cranial nerves X and XI dysfunction, manifesting as severe vocal cord paralysis (dysphonia), dysphagia, asymmetric palate elevation/deviation and trapezius muscle atrophy, in addition to scalene muscle atrophy. After an extensive workup, the patient’s symptoms were determined to be due to sequelae of varicella zoster infection, which was confirmed with antibody titers. The patient’s dysphagia and dysphonia eventually improved with vocal cord medialisation injection and Botox injection. However, despite delayed treatment with acyclovir and valacyclovir, the patient continued to have neuropathic pain and exhibit signs of CN X and CN XI paresis, in addition to scalene muscle atrophy.

  • general practice / family medicine
  • cranial nerves
  • infection (neurology)
  • pain (neurology)
  • ear, nose and throat/otolaryngology

Statistics from Altmetric.com

Footnotes

  • Contributors ZW and TL meet the following requirements for authorship: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published; AND Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Specifically, ZW reviewed the medical facts, did literature review, wrote the draft, made edits/suggestions to revised version, reviewed and approved the final version, and agrees to be accountable for all aspects of this case report. Specifically, TL reviewed the medical facts, did literature review, reviewed/edited the initial draft and final version, and agrees to be accountable for all aspects of this case report. JM meets the following requirements for authorship: substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND Drafting the work or revising it critically for important intellectual content; AND Final approval of the version to be published; AND Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. Specifically, JM primarily cared for this Pt and conceived the case report, reviewed the medical facts, did literature review, discussed and planned with ZW and TL, reviewed and made edits to the draft to create the revised version, approved of the final version, and agrees to be accountable for all aspects of this case report.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.