Disseminated Herpes Zoster Infection with Urinary Retention and Incontinence

Abstract

Herpes zoster is one of the most commonly encountered dermatological diseases. Disseminated herpes zoster is one of the severe forms of a herpes zoster infection. Patients with herpes zoster occasionally experience urinary retention and incontinence, which can greatly affect their quality of life. Urinary retention and incontinence appear to improve with or after the treatment of herpes zoster. There are some reports of urinary retention caused by herpes zoster, but case reports of incontinence are rare. Here a case of disseminated herpes zoster is reported that caused both urinary retention and incontinence. An 87-year-old woman visited the JR Tokyo General Hospital with complaints of erythema and headache in the right forehead, pain in the left buttock, and urinary retention that had started two days prior. Two days after the onset, the patient was hospitalized (Day 0) and treatment with acyclovir (750 mg/day) was initiated. For urinary retention, in addition to indwelling a urinary catheter, distigmine bromide at 5 mg/day was initiated. After admission, the patient experienced bowel incontinence on Day 1. Continued acyclovir treatment eliminated the blisters and alleviated pain, and incontinence did not reoccur after Day 2. At the end of the acyclovir administration, an attempt was made to remove the urinary tract catheter, but the catheter was reinserted the same day because urinary retention continued. The urinary tract catheter was ultimately removed on Day 36, after which urinary retention did not reoccur, even after distigmine bromide treatment was completed on Day 71. Similar to previous reports., it is thought that a skin rash on the head or buttocks or the onset of the disease in the elderly may be an indication for disease course with higher risk of incontinence. As the case described here was of an elderly woman with disseminated herpes zoster with skin eruptions on the face and left buttock, the combination of symptoms and the patient’s older age placed her at higher risk for incontinence. Patients with herpes zoster on the face who were previously reported with urinary retention also had a skin rash on the trunk. Urinary retention without a skin rash on the trunk is considered rare. Moreover, blood tests for this case did not indicate renal dysfunction. Urinary disorders due to herpes zoster and renal dysfunction identified by blood tests may not be related.