Postherpetic Neuralgia Mimicking Renal Colic: Zoster Sine Herpete with Segmental Thoracic Motor Paresis

International Journal of Pain International Journal of Pain Varicella zoster virus (VZV) is a herpes virus that causes chickenpox in childhood. The virus migrates to the dorsal root and then remains dormant in the ganglia. In some patients, VZV may reactivate and spread to the sensory pathways. It can typically produce neuritis with prodromal pain, unilateral rash and vesicular eruptions in a restricted dermatomal distribution [1]. In most patients, a clinical diagnosis of herpes zoster is readily made when a rash appears. However, some patients have herpes zosters without the zosteriform rash (zoster sine herpete, ZSH). ZSH is uncommon and the incidence of ZSH is truly unknown. Moreover, the zoster sine herpete with visible thoracic motor paralysis in segment and involved sensory dermatomes is rare. A few cases of zoster sine herpete with segmental motor paralysis were reported [2]. Besides, it is difficult to accurately diagnose the ZSH and even it can be seriously misdiagnosed as a urolithiasis, appendicitis, biliary or renal colic, cholecystitis, duodenal ulcer. We report a case of ZSH with abdominal wall protrusion misdiagnosed as a ureter stone.