Shingles Without Rash – Long Term Pain Especially Neck-Arm Radiculopathy

Recently discovered that there is a whole subset of neck sciatica/cervical radiculopathy that does not have MRI evidence of disc protrusion but give a much increased hisotry of remote shingles episode. It is suggested this is herpes zoster without rash – ie. Zoster sine Herpete. This condition was recently compared to shingles with rash and found to have pains that are worse and last longer.

Gumina, Stefano, et al.
Shoulder pain due to cervical radiculopathy: an underestimated long-term complication of herpes zoster virus reactivation?.
International orthopaedics 42.1 (2018): 157-160.

  • Took cases of cervical radiculopathy
  • MRI positive cases gave a 18.4% hisotry of Zoster
  • MRI negative cases had a 81.6% history of shingles – often remote ie. at least several years or more back
  • Hence cervical radiculitis often with full range of motion and no MRI findings is likely Zoster sine Herpete.
  • The prognosis of this condition is worse than those who get a rash:

J Med Virol. 2018 Sep in press
Acute pain and post-herpetic neuralgia related to Varicella Zoster Virus reactivation: comparison between typical herpes zoster and zoster sine herpete.
Drago F et al

  • compared cases of unilateral neurogenic pain associated with or without rash but lab evidence of herpes zoster infection (Zoster DNA in blood and antibody changes)
  • Took cases seen within 5 days and treated with antivirals within 5 days
  • Results showed those without rash and worse pain that was more persistent

sine neuralgia worst

Comment – I have seen two cases of cervical radiculitis that were puzzling – they had full range of motion and negative spurling signs. I treated both with vancyclovir 1 gm tid x7 days. One case was better and other the numbness disappeared by day 4 but she continued to have 50% of the pain. Now I see this is a very painful condition.




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