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Acute herpes zoster radiculopathy mimicking cervical radiculopathy after ChAdOx1 nCoV-19/AZD1222 vaccination
  1. Andrew Dermawan1,
  2. Matthew Jun Min Ting2,
  3. Thomas Chemmanam3,4 and
  4. Chok Lui2
  1. 1General Medicine, Royal Perth Hospital, Perth, Western Australia, Australia
  2. 2Geriatric department, St John of God Midland Public and Private Hospitals, Midland, Western Australia, Australia
  3. 3Neurology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  4. 4Neurology, St John of God Midland Public and Private Hospital, Midland, Australian Capital Territory, Australia
  1. Correspondence to Dr Andrew Dermawan; andrew.dermawan{at}health.wa.gov.au

Abstract

This case report describes an 84-year-old man who presented with 3 weeks of gradually worsening right arm weakness associated with a painful vesicular rash across his arm. This occurred 3 days after his first dose of the ChAdOx1 nCoV-19/AZD1222 (University of Oxford, AstraZeneca and the Serum Institute of India) vaccine. The diagnosis was complicated by the presence of right C5–C6 foraminal stenosis compressing on the C6 nerve root sheath on non-contrast MRI, leading to an initial diagnosis of cervical radiculopathy. However, a positive varicella zoster virus-PCR test and findings of abnormal contrast enhancement of his right C5–C7 nerve roots on gadolinium-enhanced MRI resulted in a revision of his diagnosis to zoster radiculopathy. He was subsequently commenced on oral valacilovir and made significant recovery. This report aims to highlight the diagnostic dilemma between cervical radiculopathy secondary to spondylosis and zoster radiculopathy and how an erroneous diagnosis could result in inappropriate, aggressive surgical intervention and delayed treatment with antiviral therapy.

  • COVID-19
  • Vaccination/immunisation
  • Peripheral nerve disease
  • Unwanted effects / adverse reactions

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Footnotes

  • Contributors AD is the primary author of the case report. MT contributed with the discussion section of the case report and editing the draft. TC is the neurologist involved with the investigation, diagnosis and management of the patient. He contributed to the case presentation and investigation section. CL is the geriatrician consultant who manages the patient overall. He also is the overall supervisor of the 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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