HSV-2 sacral radiculitis (Elsberg syndrome)

A self-limiting syndrome of acute urinary retention in combination with variable other signs of spinal cord dysfunction and CSF pleocytosis was described by Elsberg >70 years ago.1 In many instances, a viral etiology is found, and herpes simplex virus type 2 (HSV-2) reactivation from spinal ganglia is the most common associated infection. Lumbosacral involvement in neoplastic disease, as also reported by Elsberg, is rare. The clinical presentation of mostly younger patients with signs of acute radiculomyelitis, such as transient urinary retention and sensory lumbosacral symptoms, is thus referred to as Elsberg syndrome. Sexually active women are preferentially affected, adolescents only rarely. We report a 40-year-old woman who developed sensory loss in a lower sacral dermatome distribution, dull pain in the buttock region, and acute urinary retention. There were no motor symptoms, no obstipation, no fever, and no rash. CSF showed lymphocytic pleocytosis (162/μL) with elevated albumin (690 mg/dL). Serum HSV-2 immunoglobulin (Ig) M and IgG titers …