title: Herpes zoster sciatica mimicking lumbar canal stenosis: a case report.
abstract: BACKGROUND
  Symptom of herpes zoster is sometimes difficult to distinguish from sciatica induced by spinal diseases, including lumbar disc herniation and spinal canal stenosis. Here we report a case of sciatica mimicking lumbar canal stenosis.
  
  
  METHODS
  A 74-year-old Chinese male patient visited our hospital for left-sided sciatic pain upon standing or walking for 5 min of approximately 1 month's duration. At the first visit to our hospital, there were no skin lesions. A magnetic resonance imaging showed spinal canal stenosis between the 4th and 5th lumbar spine. Thus, we diagnosed the patient with sciatica induced by spinal canal stenosis. We considered decompression surgery for the stenosis of 4th and 5th lumbar spine because conservative therapy failed to relieve the patient's symptom. At that time, the patient complained of a skin rash involving his left foot for several days. A vesicular rash and erythema were observed on the dorsal and plantar surfaces of the great toe and lateral malleolus. The patient was diagnosed with herpes zoster in the left 5th lumbar spinal nerve area based on clinical findings, including the characteristics of the pain and vesicular rash and erythema in the 5th lumbar spinal dermatome. The patient was treated with famciclovir (1,500 mg/day) and non-steroidal anti-inflammatory drugs. After 1 week of medication, the skin rash resolved and pain relief was obtained.
  
  
  CONCLUSIONS
  In conclusion, spinal surgeons should keep in mind herpes zoster infection as one of the possible differential diagnoses of sciatica, even if there is no typical skin rash.
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan. masaokod@gmail.com.|Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan. masaokod@gmail.com.
authors.forename: Masao
authors.initials: M
authors.lastname: Koda
authors.affiliation: Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan. chikato@fj8.so-net.ne.jp.
authors.forename: Chikato
authors.initials: C
authors.lastname: Mannoji
authors.affiliation: Department of Dermatology, Chiba Aoba Municipal Hospital, Chiba, Japan. y.oikawa-1979@hotmail.co.jp.
authors.forename: Makiko
authors.initials: M
authors.lastname: Oikawa
authors.affiliation: Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan. murakami-3@mwa.biglobe.ne.jp.
authors.forename: Masazumi
authors.initials: M
authors.lastname: Murakami
authors.affiliation: Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan. zuzuchanokamoto@gmail.com.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Okamoto
authors.affiliation: Department of Orthopedic Surgery, Chiba Aoba Municipal Hospital, Chiba, Japan. tkmdphd@gmail.com.
authors.forename: Tamiyo
authors.initials: T
authors.lastname: Kon
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan. d23057272@yahoo.co.jp.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Okawa
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan. osamu_ik@zd5.so-net.ne.jp.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.affiliation: Department of Orthopedic Surgery, Tsukuba University, Ibaraki, Japan. masashiy@md.tsukuba.ac.jp.
authors.forename: Masashi
authors.initials: M
authors.lastname: Yamazaki
authors.affiliation: Department of Orthopedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-Ku, Chiba, 260-8670, Japan. takeo251274@yahoo.co.jp.
authors.forename: Takeo
authors.initials: T
authors.lastname: Furuya
mesh_terms: D015075:2-Aminopurine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use*; D003251:Constriction, Pathologic / Q000151:congenital* / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D003937:Diagnosis, Differential; D000077595:Famciclovir; D006562:Herpes Zoster / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D006801:Humans; D008159:Lumbar Vertebrae / Q000002:abnormalities* / Q000187:drug effects / Q000294:innervation / Q000503:physiopathology / Q000821:virology; D008161:Lumbosacral Region / Q000294:innervation / Q000503:physiopathology / Q000821:virology; D008297:Male; D012585:Sciatica / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology / Q000821:virology; D016896:Treatment Outcome
chemical_list: D000998:Antiviral Agents; D015075:2-Aminopurine; D000077595:Famciclovir