Distinct clinical and histological features in dermatomyositis with anti‐aminoacyl‐tRNA synthetase antibodies

pacitating right foot pain. She presented with bullous eruption with red halo on her nose, anterior chest and abdomen (Fig. 1a). Also, her right thigh was swelling with a band of bullous eruption into near-circumferential erythema (Fig. 1b). She was diagnosed as having disseminated herpes zoster with atypical features. Computed tomography showed no abnormality although she complained of acute pain in her right upper thigh. Clinical laboratory investigation revealed no inflammatory response. She was treated with oral valacyclovir 500 mg three times daily for 7 days. The serological study of anti-varicella zoster virus (VZV) antibody during the acute stage revealed slight elevation of immunoglobulin (Ig)M (3.02 mL; normal, <0.8 mL) and high elevation of IgG (>128.0 mL; normal, <2.0 mL). Fifteen days after treatment, she complained of soreness and numbness in her left leg. We consulted an orthopedic surgeon for advice on her complaint. The magnetic resonance imaging (MRI) found that she suffered from a ruptured disk in the lower spine (Fig. 1c,d). Her symptoms were those of lumbar disc hernia (LDH) in the left L4 and L5 dermatomes. Herein, we reported a rare case of LDH in the left L4 and L5 dermatomes after herpes zoster infection in the right L2 and L3 dermatomes. It was reported that intervertebral disc degeneration may be caused by VZV. It seemed that our patient had pre-existing spinal canal stenosis between L3 and L4, and also L4 and L5 spinal column, by using X ray and MRI of the spine. She was affected by the reactivation of latent VZV in the right L2 lesion in this course. The distance between the L2 and L3 posterior root ganglia decreased because she had spinal canal stenosis in the region innervated by nerves running from the spinal column. As a result, L2 nerves inflamed by VZV spread to the L3 nerves lesion. Therefore, the swelling on the right side of the inflamed nerves increased stress on the left side of the spine. As a result, the right upper side of the spine was overloaded with the left lower side of the spine. For these reasons, we considered that LDH in the left L4 and L5 dermatomes was caused by herpes zoster infection in the right L2 and L3 dermatomes.