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• Vol.46 No.9
• CLINICA NEUROL, 46: 664−667, 2006
• Vol.46 No.9 contents

Brief Clinical Note

A case of herpes zoster associated Guillain-Barré syndrome with a relapse of eruptions after intravenous immunoglobulin therapy

Yuriko Nagane, M.D.¹⁾, Kimiaki Utsugisawa, M.D.¹⁾ and Daiji Obara, M.D.²⁾

¹⁾Department of Neurology, Hanamaki General Hospital
²⁾Department of Neurology, Iwate Medical University

A 77-year-old woman developed progressive dysesthesia, hypesthesia and weakness in four extremities immediately after improvement of herpes zoster in the left Th10 dermatome area. Examination of the cerebrospinal fluid (CSF) showed an increase in protein concentrations. Evidence of demyelinating polyneuropathy was demonstrated by nerve conduction studies. Her hypesthesia and weakness in the extremities were gradually improved following intravenous immunoglobulin therapy (IVIg). Varicella zoster virus (VZV) titer levels in CSF well correlated both with neurological symptoms and CSF protein concentrations. VZV DNA in the CSF was not detectable. These findings suggested autoimmune Guillain-Barré syndrome (GBS) associated with herpes zoster. An interesting finding in the present patient is that one day after the completion of IVIg, when the neurological symptoms in the extremities were apparently ameliorating, the herpes zoster eruptions again emerged in the left L3 dermatome area. By treatment with intravenous acyclovir, the vesicular eruptions were improved. We assume that IVIg might suppress the immune response against VZV and promote the recurrence of eruptions.

(CLINICA NEUROL, 46: 664−667, 2006)
key words: Guillain-Barré syndrome, herpes zoster, varicella zoster virus, acyclovir, intravenous immunoglobulin

(Received: 21-Jun-06)