[Rare differential diagnosis of left brachial pain - Case 6/2010].

METHODS

An 83-year old woman was admitted with pain in the left arm and on the left hemithorax. Subsequently, herpes zoster developed on the left arm. The next day, the patient got confused and was agitated. Furthermore, paresis of both legs and the left arm occurred.

METHODS

Cranial computed tomography was negative for intracerebral haemorrhage or ischaemia. Examination of cerebrospinal fluid revealed lymphocytic pleocytosis and increased albumin and lactate concentrations. Polymerase chain reaction (PCR) confirmed presence of varicella zoster virus DNA in the cerebrospinal fluid.

METHODS

After diagnosis of varicella zoster encephalitis, complicating herpes zoster on the left arm, intravenous treatment with aciclovir was initiated. Consequently, the patient's clinical status improved and the neurological signs declined.

CONCLUSIONS

Herpes zoster is a rare differential diagnosis of pain on the left hemithorax and may manifest without skin rashes in the initial stadium. In older patients suffering from herpes zoster, disorientation is common. However, in the presence of focal neurological deficits, varicella zoster encephalitis should definitively be ruled out by spinal tap, even if cranial imaging studies are negative.