Kosin Med J.  2024 Jun;39(2):138-143. 10.7180/kmj.23.154.

Disseminated herpes zoster with vagus nerve involvement in a kidney transplant recipient: a case report

• Kim DE
• Kim DW
• Kim HJ
• Rhee H
• Song SH
• Seong EY

• KMID: 2556812
• DOI: http://doi.org/10.7180/kmj.23.154

Abstract

Herpes zoster virus infection is common and results in significant morbidity in patients who have undergone solid organ transplantation. Herpes zoster can involve the cranial nerves, and vagus nerve involvement is an infrequent primary manifestation of herpes zoster. Here, we describe a rare presentation of disseminated herpes zoster infection with vagus nerve involvement in a kidney transplant recipient. A 62-year-old man who had undergone kidney transplantation 3 years prior presented to our clinic with sore throat and hoarseness, followed by multiple vesicular-pustular rashes on the face and trunk. Flexible laryngoscopy revealed left paramedian vocal cord paralysis with multiple ulcerative lesions extending from the left pyriform sinus to the epiglottis. Computed tomography of the neck, abdomen, and chest revealed no significant abnormalities that could have caused vocal cord paralysis. We confirmed the diagnosis of disseminated herpes zoster after herpes zoster laryngitis based on positive blood tests and polymerase chain reaction for varicella zoster virus antibodies. The skin rashes and laryngeal ulcers rapidly resolved after treatment with intravenous acyclovir and high-dose steroids. The patient still had persistent dysphagia and microaspiration as assessed by a video fluoroscopic swallowing study, but showed improvement in dysphagia in response to swallowing rehabilitation therapy. This case provides valuable insights into the presenting symptoms of disseminated herpes zoster, which can cause acute vagus neuritis in solid organ transplantation recipients.

Keyword

Case reports; Herpes zoster; Solid organ transplant; Varicella zoster virus infection

Figure

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  Fig. 1. (A, B) Multiple vesicular-pustular rashes on the face and trunk. (C) Left paramedian vocal cord paralysis with multiple ulcerative lesions extending from the left part of the pyriform sinus to the epiglottis.

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  Fig. 2. Changes in serum creatinine, trough levels of tacrolimus, and dose adjustment of immunosuppressive agents during hospitalization. IV, intravenous.

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  Fig. 3. (A) Persistent vocal cord paralysis despite resolution of laryngeal ulcers (white arrow) 2 weeks after the completion of treatment. (B) Video fluoroscopic swallowing study showing poor pharyngeal constriction with moderate liquid retention and delayed aspiration (black arrow) in the pharyngeal phase.

Reference

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