Delayed onset post-herpetic pseudohernia: a case report

Herpes zoster (HZ) is a clinical syndrome characterized by unilateral skin rash with vesicular eruptions and neuralgia along a specific dermatome. Following a childhood chickenpox infection, varicella zoster virus may remain dormant in the sensory ganglia for years. The virus may get reactivated leading to Herpes zoster. HZ primarily affects the posterior root ganglion leading to sensory symptoms such as characteristic pain in a dermatomal distribution. Segmental paresis due to zoster leading to abdominal bulge is a rare complication of herpes zoster. Thomas et al estimated the prevalence of abdominal muscle paresis due to herpes zoster as 0.2%. The pathogenesis of this motor involvement may involve immune-mediated mechanism with aseptic inflammation or direct spread of virus from the dorsal root ganglion to the anterior horn cells, adjacent motor nerve roots or peripheral nerves. The clinical picture of post herpetic pseudo hernia may mimic abdominal wall herniation leading to diagnostic dilemma. Here we present a case of post herpetic pseudo hernia misdiagnosed as abdominal wall herniation and referred to general surgery department.