Adebisi Idowu Obafemi^1,, Nicole Terese Golden¹

We report on a 59 year old man with background history of hypertension who presented to our clinic with vesicular rash of two days duration extending from the right deltoid region to the dorsum of the fingers. He was treated with Valacyclovir plus oral steroid and Tramadol after a clinical diagnosis of shingles; he represented one week later with worsening pain. At that time the vesicular rash were crusting and dry. He was diagnosed with post herpetic neuralgia and his pain medication dosage was adjusted. He represented again two weeks after the initial appearance of rash with complaints of weakness in the right upper extremity. Physical examination confirmed the weakness in the proximal and distal muscle groups of the right arm associated with weak hand and finger grips. He was then referred for electromyography and nerve conduction studies. The result showed the right ulnar motor response recording at abductor digit minimi (ADM) and first dorsal interosseous (FDI) had prolonged latency, reduced amplitude and slowed conduction velocity. The findings are most consistent with right radiculoplexoneuropathy affecting predominantly lower plexus. (EMG/NCS table). He was referred for physical therapy and regained full functions of the right upper extremity after 6 weeks of therapy. Segmental motor weakness secondary to Varicella Zoster infection is uncommon; as a result, clinicians may not suspect it and it may be confused with Parsonage-Turner syndrome, brachial plexus syndrome, cervical radiculopathy and myelopathy particularly if the rash is not obvious or absent leading to delayed diagnosis and or investigations.

shingles, brachial plexopathy, motor weakness, varicella zoster