Herpes zoster brachial plexopathy: direct steroid injection

the left C4 and C6 dermatomes. In the patient’s history, the pain started with skin lesions and resolved at the end of the second weeks with oral acyclovir therapy. The patient did not define any pain at the admittance and he had no signs of cranial nerve or meningeal involvement. The skin lesions of HZ were extinguished and widely settled to periarticular region of the left shoulder, lateral surface of the left proximal arm and the left upper back. Motor strength examination of the left upper extremity revealed that motor power was 2/5 on shoulder abduction, external rotation and elbow flexion, 3/5 on elbow extension and 4/5 on wrist and fingers. There were no pathological findings except for mild hypoesthesia at the periarticular area of left shoulder. Patient’s routine biochemical tests were within normal limits. Brain, diffusion-weighted brain and cervical magnetic resonance imaging (MRI) studies were normal at this time. Electrodiagnostic studies (EDS) revealed a brachial plexopathy affecting the upper, middle and lower trunks, but dominantly the upper trunk. The median, radial and ulnar nerves had slow conductivity whereas upper extremity muscles showed intensive degenerative properties in EDS. Moreover, brachial plexus MRI was performed and contrast media enhancement was observed at the left brachial plexus (Figures 1, 2). █ INTRODUCTION Herpes zoster (HZ) is a viral disease, caused by an exclusively human alpha herpes virus and is characterized by segmental painful skin rash and sensory symptoms. The most common complication of HZ is post-herpetic neuralgia (PHN), a syndrome characterized by neuropathic pain and allodynia in the affected region, persisting for months or even years after the rash has healed. However, motor involvement is rare, and brachial plexus neuritis is also very rare (2, 3, 6, 7, 10, 11). The main components of therapy of motor paresis or neuritis due to HZ are antiviral agents, pain therapy, and physiotherapy. Some studies have showed that the use of corticosteroids in combination with antiviral agents reduces pain and accelerates the healing process (8, 9, 11, 14). We present a case with motor involvement of shoulder due to HZ and its treatment with brachial plexus injection by interscalene approach with local anesthetic with low concentration and triamcinolone.