Abdominal paresis and pseudo-hernia secondary to herpes zoster infection: A case report and systematic analysis

BACKGROUND: Abdominal pseudo-hernia secondary to herpes zoster infection is rare and the clinical features and factors affecting recovery remain poorly understood. AIM: We aimed to describe the clinical features of patients with abdominal pseudo-hernia secondary to herpes zoster infection and attempt to identify factors associated with poor recovery. DESIGN: Literature review and retrospective Analysis. METHODS: We report a case and performed a retrospective, systematic review of the demographic background, clinical characteristics and outcomes of patients with abdominal pseudo-hernia secondary to herpes zoster infection in the literature over 20 years (2001–2021). RESULTS: We analyzed a total of 34 cases. The median age of the patients was 71.5 years. Most of the patients were male (n = 27, 79.4%). The most frequently affected dermatome was T-11 (n = 20, 66.7%). In four (12.5%) patients, abdominal pseudo-hernia started before the onset of rash. In all patients (n = 12, 100%) who underwent nerve conduction study and electromyography, there was electrophysiological evidence of acute denervation. Seven patients (20.6%) had imaging features suggestive of abdominal wall atrophy and denervation. The majority of patients had good recovery. The median follow-up time was 3 (15 days-12 months) months. Patients with pre-existing medical conditions (p = 0.03) were more likely to have a worse recovery. CONCLUSION: Abdominal pseudo-hernia is a rare complication of herpes zoster infection with a good prognosis for recovery, although patients with pre-existing disease appear to recover worse. In rare cases, it may occur before the onset of typical zoster rashes and should be suspected, especially in older, male patients with involvement of the lower thoracic dermatomes.