Epidural Steroid Enjeksiyonu Sonrasında Gelişen Bir Herpes Zoster Olgusu
Herpes zoster arka kök ganglionlarında latent olarak kalan Herpes zoster virüsün, özellikle malignite, enfeksiyon, steroid kullanımı veya kronik böbrek yetmezliği gibi bağışıklık sisteminin baskılandığı durumlarda reaktivasyonu sonucu oluşur. Bunların bir kısmında çok ağrılı seyreden post herpetik nevralji (PHN) tablosu gelişir. Literatürde PHN’nin tedavisi için epidural steroid kullanımına dair pek çok yayın varken paradoksal bir şekilde steroid enjeksiyonuna bağlı gelişen PHN yalnızca 2 olguda bildirilmiştir. Bu makalede, lumbar spinal stenozun neden olduğu bel ağrısı nedeniyle epidural steroid uygulanan kronik böbrek yetmezlikli hastadaki Herpes zoster tablosu sunuldu.
A Case of Herpes Zoster Following an Epidural Steroid Injection
Herpes Zoster occurs as a result of reactivation of Herpes zoster virus, which remains latent in the posterior root ganglia, especially in cases where the immune system is suppressed, such as malignancy, infection, use of steroidal drugs or chronic renal failure. In some of these cases a very painful postherpetic neuralgia (PHN) develops. While there are many publications on the use of epidural steroids for the treatment of PHN in the literature, in a paradoxic way, PHN induced by steroid injection has been only reported in 2 cases. In this article, a case of herpes zoster in a patient with chronic renal failure who underwent epidural steroid treatment for low back pain caused by lumbar spinal stenosis is reported.
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- Sarı S, Aydın ON, Güleser G, Kurt İ, Turan A. Effect of
transforaminal anterior epidural steroid injection on
neuropathic pain, quality of sleep and life. Ağrı.
2015;27:83-8.
https://doi.org/10.5505/agri.2015.91489
- Evans W. Intrasacral epidural injection in the treatment
of sciatica. Lancet. 1930;2:1225-9.
https://doi.org/10.1016/S0140-6736(00)86498-3
- Vorobeychik Y, Sharma A, Smith CC, et al. The
Effectiveness and Risks of Non-Image-Guided Lumbar
Interlaminar Epidural Steroid Injections: A Systematic
Review with Comprehensive Analysis of the Published
Data. Pain Medicine. 2016;17:2185-2202.
https://doi.org/10.1093/pm/pnw091
- Parsons SJ, Hawboldt GS. A previously Unrecognized
Complication of Epidural Steroids in the Treatment of
Complex Regional Pain Syndrome. Journal of Pain and
Symptom Management. 2003;25:198-9.
https://doi.org/10.1016/S0885-3924(02)00707-8
- Szokol JW, Gilbert HC. A herpes zoster outbreak temporarily associated with an epidural steroid injection,
Regional Anesthesia and Pain Medicine. 1998;23:328.
https://doi.org/10.1016/S1098-7339(98)90069-4
- Weinberg JM. Herpes zoster: epidemiology, natural
history, and common complications. J Am Acad
Dermatol. 2007; 57:130-5.
https://doi.org/10.1016/j.jaad.2007.08.046
- Manchikanti L, Knezevic NN, Boswell MV, et al. Epidural
injections for lumbar radiculopathy and spinal stenosis: a comparative systematic review and metaanalysis.
Pain Physician. 2016;19:365-410.
- Tyring SK. Management of herpes zoster and postherpetic neuralgia. J Am Acad Dermatol. 2007;57:136-42.
https://doi.org/10.1016/j.jaad.2007.09.016
- Akyol DT, Utaf S. Postherpetik Nevralji ve Tedavisi.
TÜRKDERM. 2002;36:298-302.
- Chen N, Li Q, Yang J. Antiviral treatment for preventing
postherpetic neuralgia. Cochrane Database Syst Rev.
2014;2:CD006866.
https://doi.org/10.1002/14651858.CD006866.pub3
- Forbes HJ, Bhaskaran K, Thomas SL, et al. Quantification
of risk factors for postherpetic neuralgia in herpes
zoster patients. Neurology. 2016;87:94-102.
https://doi.org/10.1212/WNL.0000000000002808
- Gauthier A, Breuer J, Carrington D, et al. Epidemiology
and cost of herpes zoster and post-herpetic neuralgia
in the United Kingdom. Epidemiol Infect. 2009;137:38-
47.
https://doi.org/10.1017/S0950268808000678
- Harpaz R, Nagel MA, Schmader K, et al. Roundtable on
postherpetic neuralgia: what, why, how long and
what’s next? Popul Health Manag. 2012;15:385-90.
https://doi.org/10.1089/pop.2012.1562
- Ifuku M, Iseki M, Hidaka I, et al. Replacement of gabapentin with pregabalin in postherpetic neuralgia therapy. Pain Med. 2011;12:1112-6.
https://doi.org/10.1111/j.1526-4637.2011.01162.x
- Esposito S, Principi N. Herpes zoster prevention: A difficult problem to solve. Vaccine. 2018;36:5442-48.
https://doi.org/10.1016/j.vaccine.2017.07.099