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Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus.

Hur J - Infect Chemother (2015)

Bottom Line: The patient complained of loss of urinary voiding sensation and constipation.No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature.Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.

ABSTRACT
When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention.

No MeSH data available.


Related in: MedlinePlus

Eschar in right flank.
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Figure 1: Eschar in right flank.

Mentions: A 25-year-old man was hospitalized after seven continuous days of fever, chills, and a general feeling of weakness. The patient's condition was acute, but he retained clear consciousness. His blood pressure was 140/70 mmHg, his pulse rate was 90 beats a minute, his respiratory rate was 20 breaths per minute, and his body temperature was 39.2℃. The patient reported feeling fatigued, pain upon urination, and pain in the anal area during urination and bowel movements. A skin rash was observed on the right side of the body, which was probably a eschar (Fig. 1). The patient was a college student with no previous illness, and nothing of note was found in terms of family history, personal history, or travel history. The patient had climbed a mountain on September 20th, about two weeks before his hospitalization. The fever and chills started one week before hospitalization, and a dark red eschar of dead skin was found on the right side of the abdomen. Because the diagnosis was scrub typhus, the patient was treated with doxycycline (100 mg orally 2 times a day for seven days). The fever began to subside three days after hospitalization. On the second day, the patient reported bloody stools and severe pain around the anus. The patient was examined by a surgeon to see if there was an anal laceration. Ultrasound was performed, but no irregularity was found. A hip bath was advised, and anti-inflammatory medicine was administered. On the sixth day of hospitalization, the pain during urination lessened, but the patient still complained about voiding dysfunction. There was no decrease in the volume or frequency of daily urination. The patient felt the need to urinate as usual but had difficulty doing so. He had to suck in his stomach to urinate, and the amount of urine produced was less than usual. Constipation started on the sixth day, and the anal sphincter was weaker than usual. On the eighth day, a skin rash, several blisters the size of rice grains, and calluses were observed on both sides of the anus (Fig. 2). A Tzanck test revealed multinuclear cells. Hypalgesia of the S1-S5 dermatomes was also observed. However, a spinal MRI did not show anything unusual. The diagnosis was scrub typhus, and acyclovir and dexamethasone were administered accordingly. Three days after the administration, the constipation improved, and from the fourth day the urinary dysfunction improved to the point of waiting a few seconds before urination and not needing to suck in the stomach anymore. The results of a blood test were as follows: white blood cell count, 4,930/mm3; hemoglobin, 14.1 g/dL; platelet count, 179,000/mm3; aspartate aminotransferase, 56 IU/L; alanine aminotransferase, 43 IU/L; blood urea nitrogen, 17.35 mg/dL; creatinine, 0.97 mg/dL; albumin, 4.43 g/dL; C-reactive protein, 7.9 mg/dL; and erythrocyte sedimentation rate, 26 mm/hour. The immunofluorescence assay titer (Green cross labs, Yongin, Korea) against Orientia tsutsugamushi increased 4-fold or more. The fact that the blisters appeared bilaterally on each buttock simultaneously without any previous history, the size of the blister, intensity of pain, and the depth of the ulcer all indicated the diagnosis more likely as herpes zoster than herpes simplex.


Sacral Herpes Zoster Associated with Voiding Dysfunction in a Young Patient with Scrub Typhus.

Hur J - Infect Chemother (2015)

Eschar in right flank.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4495275&req=5

Figure 1: Eschar in right flank.
Mentions: A 25-year-old man was hospitalized after seven continuous days of fever, chills, and a general feeling of weakness. The patient's condition was acute, but he retained clear consciousness. His blood pressure was 140/70 mmHg, his pulse rate was 90 beats a minute, his respiratory rate was 20 breaths per minute, and his body temperature was 39.2℃. The patient reported feeling fatigued, pain upon urination, and pain in the anal area during urination and bowel movements. A skin rash was observed on the right side of the body, which was probably a eschar (Fig. 1). The patient was a college student with no previous illness, and nothing of note was found in terms of family history, personal history, or travel history. The patient had climbed a mountain on September 20th, about two weeks before his hospitalization. The fever and chills started one week before hospitalization, and a dark red eschar of dead skin was found on the right side of the abdomen. Because the diagnosis was scrub typhus, the patient was treated with doxycycline (100 mg orally 2 times a day for seven days). The fever began to subside three days after hospitalization. On the second day, the patient reported bloody stools and severe pain around the anus. The patient was examined by a surgeon to see if there was an anal laceration. Ultrasound was performed, but no irregularity was found. A hip bath was advised, and anti-inflammatory medicine was administered. On the sixth day of hospitalization, the pain during urination lessened, but the patient still complained about voiding dysfunction. There was no decrease in the volume or frequency of daily urination. The patient felt the need to urinate as usual but had difficulty doing so. He had to suck in his stomach to urinate, and the amount of urine produced was less than usual. Constipation started on the sixth day, and the anal sphincter was weaker than usual. On the eighth day, a skin rash, several blisters the size of rice grains, and calluses were observed on both sides of the anus (Fig. 2). A Tzanck test revealed multinuclear cells. Hypalgesia of the S1-S5 dermatomes was also observed. However, a spinal MRI did not show anything unusual. The diagnosis was scrub typhus, and acyclovir and dexamethasone were administered accordingly. Three days after the administration, the constipation improved, and from the fourth day the urinary dysfunction improved to the point of waiting a few seconds before urination and not needing to suck in the stomach anymore. The results of a blood test were as follows: white blood cell count, 4,930/mm3; hemoglobin, 14.1 g/dL; platelet count, 179,000/mm3; aspartate aminotransferase, 56 IU/L; alanine aminotransferase, 43 IU/L; blood urea nitrogen, 17.35 mg/dL; creatinine, 0.97 mg/dL; albumin, 4.43 g/dL; C-reactive protein, 7.9 mg/dL; and erythrocyte sedimentation rate, 26 mm/hour. The immunofluorescence assay titer (Green cross labs, Yongin, Korea) against Orientia tsutsugamushi increased 4-fold or more. The fact that the blisters appeared bilaterally on each buttock simultaneously without any previous history, the size of the blister, intensity of pain, and the depth of the ulcer all indicated the diagnosis more likely as herpes zoster than herpes simplex.

Bottom Line: The patient complained of loss of urinary voiding sensation and constipation.No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature.Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Yeungnam University Medical Center, Daegu, Korea.

ABSTRACT
When a patient presents with acute voiding dysfunction without a typical skin rash, it may be difficult to make a diagnosis of herpes zoster. Here, we present a case of scrub typhus in a 25-year-old man with the complication of urinary dysfunction. The patient complained of loss of urinary voiding sensation and constipation. After eight days, he had typical herpes zoster eruptions on the sacral dermatomes and hypalgesia of the S1-S5 dermatomes. No cases of dual infection with varicella zoster virus and Orientia tsutsugamushi were found in the literature. In the described case, scrub typhus probably induced sufficient stress to reactivate the varicella zoster virus. Early recognition of this problem is imperative for prompt and appropriate management, as misdiagnosis can lead to long-term urinary dysfunction. It is important that a diagnosis of herpes zoster be considered, especially in patients with sudden onset urinary retention.

No MeSH data available.


Related in: MedlinePlus