右上肢麻痺を来した帯状疱疹性腕神経叢炎の 1 例

An 81-year-old woman who developed herpes zoster infection that involved the area from her right shoulder to her forearm visited our department; she was hospitalized because of severe pain. Her right upper limb movement had been compromised since admission; however, accurate evaluation was difficult because of the severe pain. The pain considerably reduced by day 5 under treatment with intravenous acyclovir 500 mg/day, sulbactam/ampicillin 1125 mg/day, and oral acetaminophen 1200 mg/day and pregabalin 50 mg/day. However, her right limb motor paralysis persisted. Neurological examination revealed muscle weakness corresponding to the C5 and C6 regions, and magnetic resonance imaging identified high T2 signal in the right brachial plexus neuritis. She was diagnosed with right brachial plexopathy secondary to herpes zoster infection. After incrustation of all the vesicles and blisters on day 9, she was transferred to our neurology department. Two sessions of steroid pulse therapy (methylprednisolone 1 g/day for 3 consecutive days)and daily oral prednisolone 45 mg/day (1 mg/kg/day)failed to achieve any improvement in terms of her right limb motor paralysis. However, intravenous immunoglobulin administered from day 28 effectively reduced her symptoms. After the administration of additional steroid pulse therapy, oral prednisolone was tapered from day 45, and she was discharged from our hospital on day 54. Herpes zoster infection is common; however, recently, the number of cases, particularly those among elderly subjects, is increasing. Live-attenuated and subunit vaccination of herpes zoster are covered by national insurance since March 2016 and March 2018, respectively, for people aged ≥ 50 years; however, this facility has not been utilized extensively thus far. In order to reduce the number of serious neuro-related complications of herpes zoster that could potentially affect a patient's daily routine activities, affirmative herpes zoster vaccinations for the elderly are recommended.