Elsberg syndrome, or HSV-2 lumbosacral radiculitis, is a rare and underrecognized neurologic condition that mimics cauda equina syndrome (CES). It typically presents with symptoms such as urinary retention, saddle ane...Elsberg syndrome, or HSV-2 lumbosacral radiculitis, is a rare and underrecognized neurologic condition that mimics cauda equina syndrome (CES). It typically presents with symptoms such as urinary retention, saddle anesthesia, and bowel incontinence. This case report describes a 59-year-old immunosuppressed male with idiopathic pulmonary fibrosis who developed Elsberg syndrome due to re-activation of latent HSV-2. The patient experienced progressive lower extremity sensory deficits and genitourinary dysfunction, culminating in a vesiculopustular rash. Diagnosis was confirmed via cerebrospinal fluid analysis and PCR testing of skin lesions. Despite early imaging findings being unremarkable, subsequent MRI revealed enhancement of the conus medullaris and cauda equina. Treatment with intravenous acyclovir, corticosteroids, and supportive therapy led to gradual functional improvement, though sensory deficits and neuropathy persisted. This case highlights the diagnostic challenges and importance of clinical suspicion for HSV-2 reactivation in immunosuppressed patients, as well as considerations for long-term symptom management.展开更多
BACKGROUND Elsberg syndrome is a type of postinfectious lumbosacral radiculitis typically tri-ggered by neurotropic viruses and manifests as bladder/bowel dysfunction,saddle sensory disturbances(including hypoesthesia...BACKGROUND Elsberg syndrome is a type of postinfectious lumbosacral radiculitis typically tri-ggered by neurotropic viruses and manifests as bladder/bowel dysfunction,saddle sensory disturbances(including hypoesthesia,hyperesthesia,or dyse-sthesia),and variable neurological deficits.Typically self-limiting,it often res-ponds to antiviral and neurotropic therapies.However,in patients with comorbi-dities that confer susceptibility to peripheral neuropathy(e.g.,diabetes mellitus),timely escalation to neuromodulation strategies,such as spinal cord stimulation,may be warranted to optimize functional outcomes when conservative measures are inadequate.CASE SUMMARY A 60-year-old male with diabetes mellitus presented with severe bladder and bowel dysfunction persisting for more than two months,followed by left gluteal and perianal(saddle area)herpes zoster eruption that was accompanied by significant neuropathic pain.Following a suboptimal response to conservative therapy,the patient underwent implantation of a short-term spinal cord stimu-lation.Following a 10-day trial of continuous tonic stimulation,the percutaneous electrode lead was removed.The patients experienced no surgical complications,and after the procedure,the patient achieved complete restoration of bladder and bowel function and significant pain alleviation.Two-month follow-up confirmed sustained full recovery.CONCLUSION Early implementation of short-term spinal cord stimulation represents a pro-mising therapeutic approach for promoting neurological recovery in patients with Elsberg syndrome refractory to conservative management,especially those with predisposing comorbidities such as diabetes mellitus.展开更多
文摘Elsberg syndrome, or HSV-2 lumbosacral radiculitis, is a rare and underrecognized neurologic condition that mimics cauda equina syndrome (CES). It typically presents with symptoms such as urinary retention, saddle anesthesia, and bowel incontinence. This case report describes a 59-year-old immunosuppressed male with idiopathic pulmonary fibrosis who developed Elsberg syndrome due to re-activation of latent HSV-2. The patient experienced progressive lower extremity sensory deficits and genitourinary dysfunction, culminating in a vesiculopustular rash. Diagnosis was confirmed via cerebrospinal fluid analysis and PCR testing of skin lesions. Despite early imaging findings being unremarkable, subsequent MRI revealed enhancement of the conus medullaris and cauda equina. Treatment with intravenous acyclovir, corticosteroids, and supportive therapy led to gradual functional improvement, though sensory deficits and neuropathy persisted. This case highlights the diagnostic challenges and importance of clinical suspicion for HSV-2 reactivation in immunosuppressed patients, as well as considerations for long-term symptom management.
基金Supported by the Science and Technology Department of Sichuan Province,No.2023YFS0255。
文摘BACKGROUND Elsberg syndrome is a type of postinfectious lumbosacral radiculitis typically tri-ggered by neurotropic viruses and manifests as bladder/bowel dysfunction,saddle sensory disturbances(including hypoesthesia,hyperesthesia,or dyse-sthesia),and variable neurological deficits.Typically self-limiting,it often res-ponds to antiviral and neurotropic therapies.However,in patients with comorbi-dities that confer susceptibility to peripheral neuropathy(e.g.,diabetes mellitus),timely escalation to neuromodulation strategies,such as spinal cord stimulation,may be warranted to optimize functional outcomes when conservative measures are inadequate.CASE SUMMARY A 60-year-old male with diabetes mellitus presented with severe bladder and bowel dysfunction persisting for more than two months,followed by left gluteal and perianal(saddle area)herpes zoster eruption that was accompanied by significant neuropathic pain.Following a suboptimal response to conservative therapy,the patient underwent implantation of a short-term spinal cord stimu-lation.Following a 10-day trial of continuous tonic stimulation,the percutaneous electrode lead was removed.The patients experienced no surgical complications,and after the procedure,the patient achieved complete restoration of bladder and bowel function and significant pain alleviation.Two-month follow-up confirmed sustained full recovery.CONCLUSION Early implementation of short-term spinal cord stimulation represents a pro-mising therapeutic approach for promoting neurological recovery in patients with Elsberg syndrome refractory to conservative management,especially those with predisposing comorbidities such as diabetes mellitus.
