SHM Converge Scientific Abstract ePoster Gallery-Siadh a Rare Complication of Cutaneous Herpes Zoster

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An 83-year-old woman with a history of SLE, rheumatoid arthritis, B-cell lymphoma in remission, and hypothyroidism presented with 4 days of atraumatic lower back pain, vomiting, weight loss, and a dermatomal erythematous rash on the left lower back/hip consistent with cutaneous herpes zoster. On exam she was cachectic but hemodynamically stable and euvolemic.<br /><br />Initial labs showed hypotonic hyponatremia with serum sodium 127 mEq/L, low serum osmolality, high urine sodium and osmolality, low uric acid, and normal cortisol and TSH. Imaging (CXR and CT abdomen/pelvis) was unrevealing. She was initially treated with IV fluids for poor oral intake, valacyclovir for suspected zoster, and pain control. However, her sodium worsened to 124 mEq/L, and the laboratory picture was consistent with SIADH.<br /><br />After common causes of SIADH were excluded, the cutaneous herpes zoster infection was considered the most likely trigger. Management was changed to fluid restriction, oral urea, and a dose of tolvaptan, which improved serum sodium. At 1-month follow-up, sodium remained stable and the rash had resolved, leaving only post-herpetic neuralgia.<br /><br />The report highlights that SIADH can complicate herpes zoster, even when infection is limited to the skin. Although rare, this association has been described in prior case reports. Recognizing zoster as a potential cause of SIADH is important because routine IV hydration may worsen hyponatremia. Early diagnosis and appropriate treatment can reduce morbidity, especially in older adults who are at higher risk for both zoster and complications from low sodium.

Asset Subtitle

Christopher Eppel

Meta Tag

Author List Alexandra Gottdiener, Christopher Eppel, Heeho Kim, Joseph Fleischer, Ross Lavine

Category Clinical Vignettes

Concept Syndrome of Inappropriate Antidiuretic Hormone Secretion

Concept Cutaneous Herpes Zoster

Concept Hypotonic Hyponatremia

Concept Fluid Restriction

Concept Serum Osmolality

Distinguished Non-Finalist

Presenter Organization Englewood Hospital Internal Medicine

Presenting Author Christopher Eppel

Track Adult

Keywords

SIADH

hyponatremia

herpes zoster

cutaneous zoster

elderly patient

low serum osmolality

urine sodium

tolvaptan

fluid restriction

post-herpetic neuralgia

Syndrome of Inappropriate Antidiuretic Hormone Secretion

Cutaneous Herpes Zoster

Hypotonic Hyponatremia

Fluid Restriction

Serum Osmolality