Myelitis with zoster sine herpete in a hemodialysis patient

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  • Hamada Masahiro
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Morikawa Takashi
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Yamazaki Daisuke
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Takeuchi Yuka
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Ohno Yoshiteru
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Shibata Mikiko
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Kishida Masatsugu
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Imanishi Masahito
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Kitabayashi Chizuko
    Department of Nephrology and Hypertension, Osaka City General Hospital
  • Konishi Yoshio
    Department of Nephrology and Hypertension, Osaka City General Hospital

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Other Title
  • 無疹性帯状疱疹に伴う脊髄炎を生じた血液透析患者の1例
  • 症例報告 無疹性帯状庖疹に伴う脊髄炎を生じた血液透析患者の1例
  • ショウレイ ホウコク ムシンセイ タイジョウホウシン ニ トモナウ セキズイエン オ ショウジタ ケツエキ トウセキ カンジャ ノ 1レイ

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Abstract

A 66-year-old man who had been diagnosed with type 2 diabetes at the age of 32 was started on hemodialysis when he was 52 years old due to end-stage renal disease caused by hepatitis C-associated membranoproliferative glomerulonephritis. In February X, he developed lower back pain, followed by left leg muscle weakness and bilateral leg pain. This resulted in difficulty walking, and he was hospitalized. Magnetic resonance imaging showed spinal cord swelling at the thoracic spine 2-3 level, and T1- and T2-weighted imaging of the left side showed an area of faint hyperintensity. An examination of the patient’s cerebrospinal fluid produced positive results for varicella-zoster virus, but no rash was evident. Myelitis associated with zoster sine herpete was therefore diagnosed. Patients with decreased immune function are less likely to develop a rash after herpes zoster virus infection, which can make diagnosis difficult in such patients. In the present case, diabetes, liver cirrhosis, and renal failure probably contributed to the patient’s immunocompromised state.

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