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August 2009

Atypical Herpes Zoster Infection Preceded by Sciatica and Foot Drop

Arch Dermatol. 2009;145(8):954-955. doi:10.1001/archdermatol.2009.168

Motor neuropathy rarely complicates herpes zoster infection. When a motor neuropathy develops from a herpes zoster infection, it usually follows the skin manifestations and mainly affects the facial musculature. However, we report a case of sciatica and foot drop that presented before the cutaneous eruption.

A 79-year-old white woman felt sciatic pain on her right side and paresthesias over her right buttock. Four days later, she developed a right foot drop. Two days after that, right-sided petechiae erupted on her sacrum and along the anterior surface of her right leg and foot, all in the L4/L5 dermatome. Moreover, she was unable to dorsiflex her right foot or great toe (Figure 1). The month before, she had started taking 60 mg/d of prednisone for temporal arteritis. Interestingly, she had 3 prior cases of herpes zoster and 2 cases of temporary Bell palsy.

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