SHM Converge Scientific Abstract ePoster Gallery-When Zoster Strikes Twice: Zoster-Associated Cranial Neuritis and Poly-Radiculitis

Pdf Summary

This case report describes a 53-year-old man with diabetes and hypertension who developed rare neurological complications after a recent herpes zoster outbreak. He initially had a right facial rash treated briefly with valacyclovir, followed by postherpetic neuralgia. About a month later, he returned with right facial swelling, worsening pain, headache, facial droop, and progressive right arm and leg weakness.<br /><br />Examination showed crusted shingles lesions along the right trigeminal distribution and signs of right facial nerve palsy, including inability to close the eye. Limb weakness suggested poly-radiculitis. MRI of the brain showed enhancement of the right facial nerve, and lumbar imaging revealed a small enhancing focus near the T12-L1 level, supporting nerve involvement from varicella-zoster virus (VZV) reactivation.<br /><br />He was diagnosed with zoster-associated cranial neuritis and right-sided poly-radiculitis. Treatment included 14 days of intravenous acyclovir, oral prednisone, pain control, artificial tears, eye protection, and rehabilitation therapies. He improved rapidly after therapy.<br /><br />The report emphasizes that herpes zoster can cause serious neurologic complications beyond the typical rash and pain, especially in patients with risk factors such as diabetes or immunosuppression. Cranial neuritis and radiculitis are uncommon but can produce multiple focal deficits. Early recognition, MRI findings of nerve enhancement, and prompt antiviral treatment are important for recovery. Although corticosteroid use remains debated, it may help in severe inflammatory cases.<br /><br />Overall, the case highlights the need for high clinical suspicion when shingles is accompanied by neurologic symptoms, and it supports early antiviral treatment with multidisciplinary supportive care to improve outcomes.

Asset Subtitle

Zain Khan

Meta Tag

Author List Lucas Hopkins, Zain Khan

Category Clinical Vignettes

Concept Varicella-Zoster Reactivation

Concept Neurologic complication

Concept Cranial Neuritis

Concept Cranial nerve VII

Concept Antiviral Therapy

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone Internal Medicine

Presenting Author Zain Khan

Track Adult

Keywords

herpes zoster

varicella-zoster virus

cranial neuritis

poly-radiculitis

facial nerve palsy

postherpetic neuralgia

MRI nerve enhancement

intravenous acyclovir

diabetes mellitus

neurologic complications

Varicella-Zoster Reactivation

Neurologic complication

Cranial Neuritis

Cranial nerve VII

Antiviral Therapy