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Disseminated Herpes Zoster Infection with Urinary Retention and Incontinence

Received: 21 June 2020    Accepted: 9 July 2020    Published: 17 July 2020
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Abstract

Herpes zoster is one of the most commonly encountered dermatological diseases. Disseminated herpes zoster is one of the severe forms of a herpes zoster infection. Patients with herpes zoster occasionally experience urinary retention and incontinence, which can greatly affect their quality of life. Urinary retention and incontinence appear to improve with or after the treatment of herpes zoster. There are some reports of urinary retention caused by herpes zoster, but case reports of incontinence are rare. Here a case of disseminated herpes zoster is reported that caused both urinary retention and incontinence. An 87-year-old woman visited the JR Tokyo General Hospital with complaints of erythema and headache in the right forehead, pain in the left buttock, and urinary retention that had started two days prior. Two days after the onset, the patient was hospitalized (Day 0) and treatment with acyclovir (750 mg/day) was initiated. For urinary retention, in addition to indwelling a urinary catheter, distigmine bromide at 5 mg/day was initiated. After admission, the patient experienced bowel incontinence on Day 1. Continued acyclovir treatment eliminated the blisters and alleviated pain, and incontinence did not reoccur after Day 2. At the end of the acyclovir administration, an attempt was made to remove the urinary tract catheter, but the catheter was reinserted the same day because urinary retention continued. The urinary tract catheter was ultimately removed on Day 36, after which urinary retention did not reoccur, even after distigmine bromide treatment was completed on Day 71. Similar to previous reports., it is thought that a skin rash on the head or buttocks or the onset of the disease in the elderly may be an indication for disease course with higher risk of incontinence. As the case described here was of an elderly woman with disseminated herpes zoster with skin eruptions on the face and left buttock, the combination of symptoms and the patient’s older age placed her at higher risk for incontinence. Patients with herpes zoster on the face who were previously reported with urinary retention also had a skin rash on the trunk. Urinary retention without a skin rash on the trunk is considered rare. Moreover, blood tests for this case did not indicate renal dysfunction. Urinary disorders due to herpes zoster and renal dysfunction identified by blood tests may not be related.

Published in International Journal of Infectious Diseases and Therapy (Volume 5, Issue 3)
DOI 10.11648/j.ijidt.20200503.12
Page(s) 48-50
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Disseminated Herpes Zoster, Urinary Retention, Incontinence, Urethral Catheter, Distigmine Bromide

References
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[3] Bloch, K. C. and Johnson, J. G. (2012). Varicella zoster virus transmission in the vaccine era: unmasking the role of herpes zoster. Journal of Infectious Diseases 205: 1331-1333.
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[7] McLaughlin, J. M., McGinnis, J. J., Tan, L., Mercatante, A., and Fortuna, J. (2015). Estimated human and economic burden of four major adult vaccine-preventable diseases in the United States, 2013. Journal of Primary Prevention 36: 259-273.
[8] John, A. and Canaday, D. H. (2017). Herpes zoster in the older adult. Infectious Disease Clinics of North America 31: 811-826.
[9] Elsberg, C. A. (1913). Experiences in spinal surgery. Observations upon 60 laminectomies for spinal disease. Surgery, Gynecology & Obstetrics 16: 117-132.
[10] Mumenthaler, M., et al. Lasionen Peripherer Nerven. 155, 1977
[11] Julia J. J. and Cholhan, H. J. (2007). Herpes zoster-associated acute urinary retention: A case report. International Urogynecology Journal and Pelvic Floor Dysfunction 18: 103-104. doi: 10.1007/s00192-006-0066-1.
[12] Jellinek, E. H. and Tulloch, W. S. (1976). Herpes zoster with dysfunction of bladder and anus. Lancet 2: 1219-1222. doi: 10.1016/s0140-6736(76)91144-2.
[13] He, H., Tang, C., Yi, X., and Zhou, W. (2018). Herpes zoster-induced acute urinary retention: Two cases and literature review. Nigerian Journal of Clinical Practice 21: 534-537. doi: 10.4103/njcp.njcp_244_16.
[14] Chen L., Arai H, Chen L. Y., Chou, M. Y., Djauzi S., Dong, B. et al. Looking back to move forward: a twenty-year audit of herpes zoster in Asia-Pacific. BMC Infectious Diseases. 2017; 17: 213.
[15] Bayrak, Ö. and R. R. (2019). Dmochowski Underactive bladder: A review of the current treatment concepts. Turkish Journal of Urology 45: 401-409. doi: 10.5152/tud.2019.37659.
[16] Yoshimura, N.. and M. B. Chancellor (2004). Differential diagnosis and treatment of impaired bladder emptying. Reviews in Urology 6: S24-S31.
[17] Nagel M. A. and Gilden D. (2013) Complications of varicella zoster virus reactivation. Current Treatment Options in Neurology 15: 439-453. doi: 10.1007/s11940-013-0246-5.
[18] Saito, H., Ebashi, M., Kushimoto, M., Ikeda, J., Egashira, F., Yamaguchi, S., et al. (2018). Elsberg syndrome related to varicella zoster virus infection with painless skin lesions in an elderly woman with poorly controlled type 2 diabetes mellitus. Therapeutics and Clinical Risk Management. 14: 1951-1954. doi: 10.2147/TCRM.S178782.
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[22] Omoto, M., Matsuura, D., Fujikawa, K., Onoe, A., Handa, A., Terui, T., et al. A case of meningitis and urinary retention syndrome preceded by a generalized rash caused by Herpes zoster virus. Article in Japanese. Hihukanorinsyo 60: 457-461.
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    Yuta Norimatsu, Yuki Ohno. (2020). Disseminated Herpes Zoster Infection with Urinary Retention and Incontinence. International Journal of Infectious Diseases and Therapy, 5(3), 48-50. https://doi.org/10.11648/j.ijidt.20200503.12

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    ACS Style

    Yuta Norimatsu; Yuki Ohno. Disseminated Herpes Zoster Infection with Urinary Retention and Incontinence. Int. J. Infect. Dis. Ther. 2020, 5(3), 48-50. doi: 10.11648/j.ijidt.20200503.12

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    AMA Style

    Yuta Norimatsu, Yuki Ohno. Disseminated Herpes Zoster Infection with Urinary Retention and Incontinence. Int J Infect Dis Ther. 2020;5(3):48-50. doi: 10.11648/j.ijidt.20200503.12

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  • @article{10.11648/j.ijidt.20200503.12,
      author = {Yuta Norimatsu and Yuki Ohno},
      title = {Disseminated Herpes Zoster Infection with Urinary Retention and Incontinence},
      journal = {International Journal of Infectious Diseases and Therapy},
      volume = {5},
      number = {3},
      pages = {48-50},
      doi = {10.11648/j.ijidt.20200503.12},
      url = {https://doi.org/10.11648/j.ijidt.20200503.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20200503.12},
      abstract = {Herpes zoster is one of the most commonly encountered dermatological diseases. Disseminated herpes zoster is one of the severe forms of a herpes zoster infection. Patients with herpes zoster occasionally experience urinary retention and incontinence, which can greatly affect their quality of life. Urinary retention and incontinence appear to improve with or after the treatment of herpes zoster. There are some reports of urinary retention caused by herpes zoster, but case reports of incontinence are rare. Here a case of disseminated herpes zoster is reported that caused both urinary retention and incontinence. An 87-year-old woman visited the JR Tokyo General Hospital with complaints of erythema and headache in the right forehead, pain in the left buttock, and urinary retention that had started two days prior. Two days after the onset, the patient was hospitalized (Day 0) and treatment with acyclovir (750 mg/day) was initiated. For urinary retention, in addition to indwelling a urinary catheter, distigmine bromide at 5 mg/day was initiated. After admission, the patient experienced bowel incontinence on Day 1. Continued acyclovir treatment eliminated the blisters and alleviated pain, and incontinence did not reoccur after Day 2. At the end of the acyclovir administration, an attempt was made to remove the urinary tract catheter, but the catheter was reinserted the same day because urinary retention continued. The urinary tract catheter was ultimately removed on Day 36, after which urinary retention did not reoccur, even after distigmine bromide treatment was completed on Day 71. Similar to previous reports., it is thought that a skin rash on the head or buttocks or the onset of the disease in the elderly may be an indication for disease course with higher risk of incontinence. As the case described here was of an elderly woman with disseminated herpes zoster with skin eruptions on the face and left buttock, the combination of symptoms and the patient’s older age placed her at higher risk for incontinence. Patients with herpes zoster on the face who were previously reported with urinary retention also had a skin rash on the trunk. Urinary retention without a skin rash on the trunk is considered rare. Moreover, blood tests for this case did not indicate renal dysfunction. Urinary disorders due to herpes zoster and renal dysfunction identified by blood tests may not be related.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - Disseminated Herpes Zoster Infection with Urinary Retention and Incontinence
    AU  - Yuta Norimatsu
    AU  - Yuki Ohno
    Y1  - 2020/07/17
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    JF  - International Journal of Infectious Diseases and Therapy
    JO  - International Journal of Infectious Diseases and Therapy
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    PB  - Science Publishing Group
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    AB  - Herpes zoster is one of the most commonly encountered dermatological diseases. Disseminated herpes zoster is one of the severe forms of a herpes zoster infection. Patients with herpes zoster occasionally experience urinary retention and incontinence, which can greatly affect their quality of life. Urinary retention and incontinence appear to improve with or after the treatment of herpes zoster. There are some reports of urinary retention caused by herpes zoster, but case reports of incontinence are rare. Here a case of disseminated herpes zoster is reported that caused both urinary retention and incontinence. An 87-year-old woman visited the JR Tokyo General Hospital with complaints of erythema and headache in the right forehead, pain in the left buttock, and urinary retention that had started two days prior. Two days after the onset, the patient was hospitalized (Day 0) and treatment with acyclovir (750 mg/day) was initiated. For urinary retention, in addition to indwelling a urinary catheter, distigmine bromide at 5 mg/day was initiated. After admission, the patient experienced bowel incontinence on Day 1. Continued acyclovir treatment eliminated the blisters and alleviated pain, and incontinence did not reoccur after Day 2. At the end of the acyclovir administration, an attempt was made to remove the urinary tract catheter, but the catheter was reinserted the same day because urinary retention continued. The urinary tract catheter was ultimately removed on Day 36, after which urinary retention did not reoccur, even after distigmine bromide treatment was completed on Day 71. Similar to previous reports., it is thought that a skin rash on the head or buttocks or the onset of the disease in the elderly may be an indication for disease course with higher risk of incontinence. As the case described here was of an elderly woman with disseminated herpes zoster with skin eruptions on the face and left buttock, the combination of symptoms and the patient’s older age placed her at higher risk for incontinence. Patients with herpes zoster on the face who were previously reported with urinary retention also had a skin rash on the trunk. Urinary retention without a skin rash on the trunk is considered rare. Moreover, blood tests for this case did not indicate renal dysfunction. Urinary disorders due to herpes zoster and renal dysfunction identified by blood tests may not be related.
    VL  - 5
    IS  - 3
    ER  - 

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Author Information
  • Department of Dermatology, JR Tokyo General Hospital, Tokyo, Japan

  • Department of Dermatology, JR Tokyo General Hospital, Tokyo, Japan

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