Title : Herpes zoster complicated with an asymptomatic irreversible neurogenic bladder and end-stage renal disease case report
Abstract:
Introduction: Herpes zoster (HZ) is a viral condition resulting from varicella-zoster virus (VZV) reactivation. It typically presents with cutaneous symptoms, such as vesicular rash and dermatomal pain. In rare cases, sacral involvement of VZV can lead to a neurogenic bladder, causing bladder and urinary sphincter dysfunction. We report a case of a 36-year-old male who developed an irreversible neurogenic bladder and end-stage renal disease (ESRD) after a herpes zoster infection.
Case Presentation: Our patient is a 36-year-old male with a recent history of right thoracic HZ infection who presented to the hospital for acute kidney injury. Elevated creatinine levels and subsequent evaluations revealed bilateral hydroureter, hydronephrosis, and a severely distended urinary bladder. Despite decompression trials, bladder and kidney functions did not improve for months after presentation, and he was diagnosed with irreversible neurogenic bladder and ESRD. The workup for other possible etiologies was negative, prompting the suspicion that herpes zoster contributed to the neurogenic bladder and subsequent renal failure.
Discussion: Herpes zoster virus can reactivate in immunocompromised or older individuals, affecting various neurological and visceral systems. In this case, inflammation of the sacral nerves is believed to have played a role in the development of the neurogenic bladder and subsequent ESRD. While previously reported VZV-induced bladder dysfunction cases were mostly reversible, this case was asymptomatic, irreversible, and followed by unresolved AKI and subsequent ESRD.
Therefore, vigilant monitoring of renal function is crucial in patients with HZ with or without reported urinary voiding dysfunction to identify potential progression to renal failure. Additionally, screening for urinary retention should be considered, especially with thoracic, lumbar, and sacral dermatomal HZ involvement, given the simplicity of the test and the severity of complications if missed.
Conclusion: This case report emphasizes the significance of recognizing HZ as a potential cause of neurogenic bladder and its uncommon yet severe complication leading to ESRD. Timely identification and appropriate management of HZ can potentially prevent irreversible bladder dysfunction and renal failure in affected individuals. Further research is warranted to better understand the underlying mechanisms of VZV-induced neurogenic bladder and its potential progression to ESRD. Also, to determine the importance of urinary retention screening and kidney function monitoring.
