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Presenting as sciatica,Lesion was Sacral herpes zoster

A 70y-old man was admitted to hospital because of multiple injuries from a traffic collision. On day 16 after admission, he started to complain of pain, weakness and numbness in his right leg!!

A contrast-enhanced CT scan of the lumbar spine showed a displaced sacral fracture with compression of the S1 ventral ramus.The patient’s symptoms persisted despite of treatment with diclofenac, chlor-zoxazone, fursultiamine and betamethasone.
Severe tingling pain and allodynia (pain with light touch) developed seven days later. Thirty days after admission, several painful grouped erythematous plaques with vesicles were found on his right buttock and the posterior aspect of his right leg (The figure below).

The distribution was consistent with the S1 dermatome, and a diagnosis of herpes zoster was made. The patient was prescribed valacyclovir hydrochloride, 500 mg three times daily for 5 days. The cutaneous lesions healed about seven days after the treatment was started and the tingling pain resolved gradually. The patient was discharged  42 days after admission.

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