Association of maternal nocturnal heart rate and adverse pregnancy outcomes.

Reactivation of varicella-zoster virus (VZV) causes herpes zoster (HZ), which usually presents as a unilateral vesicular eruption confined to a single dermatome. Disseminated herpes zoster (DHZ), commonly defined as more than 20 vesicles outside the primary or adjacent dermatomes, is uncommon and is classically associated with impaired cell-mediated immunity, including HIV infection, malignancy, transplantation, or immunosuppressive therapy (). In addition to its rarity in adults without an identified immunocompromising condition, DHZ may be diagnostically challenging because prodromal neuropathic pain can precede rash and mimic other disorders such as sciatica, lumbar disc herniation, or acute abdominal and neurologic conditions (–). We report a case of PCR-confirmed DHZ in an apparently immunocompetent 59-year-old woman whose initial presentation mimicked lumbar radiculopathy and led to treatment for presumed lumbar disc herniation. This case is clinically instructive for three reasons: DHZ occurred without an identifiable major acquired immunocompromising condition, early symptoms were initially attributed to incidental degenerative lumbar imaging findings, and VZV DNA was confirmed in both vesicle fluid and peripheral blood. By highlighting how disseminated VZV infection may initially resemble mechanical radicular pain, this report underscores the importance of considering herpes zoster in older adults with acute unilateral dermatomal pain even before rash appears. A 59-year-old woman who had been experiencing left thigh pain for 6 days came to the neurology department. She had first visited an orthopedic clinic due to localized, ongoing thigh pain that was not accompanied by lower back pain, weakness, or sensory symptoms. At that time, a lumbar computed tomography (CT) scan showed central-type disc herniation at the L3/L4, L4/L5, and L5/S1 levels, along with degenerative changes in the lumbar spine. Based on these findings, the patient was treated for presumed lumbar disc herniation and underwent lumbar traction therapy; during this period, the pain continued to worsen. The pain was described as burning and needle-like paroxysms lasting about 1–2 min, recurring repeatedly, and shifting between the left thigh and calf. This brief, recurrent, and shifting pain pattern was atypical for the more commonly sustained dermatomal pain associated with herpes zoster. The pain intensity was reported as 6/10 on the visual analog scale at the initial orthopedic assessment and had increased to 9/10 by the subsequent clinical evaluation, after traction therapy had been administered. The pain was distributed mainly over the posterior left thigh with radiation to the calf. The symptoms were intermittent, were aggravated by movement and touch, and were not accompanied by definite low-back pain, sphincter dysfunction, progressive motor weakness, or objective sensory loss. Local tenderness was noted, and the straight leg raise test was recorded as positive early in the course. Although lumbar CT showed degenerative disc protrusions at L3/L4, L4/L5, and L5/S1, the clinical picture was not fully concordant with compressive radiculopathy because the pain was predominantly neuropathic in quality, objective neurological deficits were absent, and subsequent serial examinations did not demonstrate progressive motor, sensory, or sphincter impairment.