Presented at the 2012 AAPM Annual Meeting « Back

Painful Foot Drop Secondary to Herpes Zoster Infection

Kevin Kohan, DO, kevinkohan@gmail.com¹, Hector Delucca, MD², (1) University of Cincinnati, Cincinnati, Ohio, (2) Albert Einstein College of Medicine-Montefiore Medical Center, Bronx, New York

Setting: Teaching Hospital. Case: A 68-year-old male with a history of diabetes mellitus presented to the emergency room with severe 5-day history of progressively worsening of left lower extremity pain accompanied by a vesicular rash. The pain was described by the patient as 10/10 with a sharp and shooting quality localized on the dorsum of the foot. On physical examination the patient had a vesicular rash with a clear exudate over the dorsum of the left foot (Figure 1). Patient developed progressive weakness of left ankle dorsiflexors with strength of 0/5 on the 11th day of admission. Patient had decreased sensation to pinprick and light touch on the dorsum of the left foot and DTR were unobtainable. Results: Cultures of the exudate were positive for Zoster (VZV) and all imagining tests were negative. Although he received a 1-week course of Valacyclovir 1000mg every 8 hours, his pain persisted. This pain was treated initially with Lyrica 50mg q12, Fentanyl patch 25mcg q72 hours, Cymbalta 60mg, and Lidocaine 1% topical patches. The pain was debilitating him and he underwent left peroneal nerve block with sensorcaine and obtained complete relief from 10/10 to 0/10 for a total of 3 days, with gradual return of pain symptoms by day 7. Patient subsequently underwent a sciatic nerve block and on 1-month follow-up his pain had subsided to a 4/10. Conclusion: A multidimension treatment modality is necessary to treat patients with recalcitrant herpes zoster.

Funding: None