Constipation and segmental abdominal paresis followed by herpes zoster.

A 66-year-old man who had medical history of hypertension presented with severe constipation, although he had previously had a regular bowel habit. Abdominal roentgenogram did not show a pattern of ileus. After four days, he felt tingling pain on the left abdominal wall and developed herpes zoster of the T11 dermatome on the left side. The left abdominal wall on which herpes zoster appeared was flaccid and distended (Picture 1). He was diagnosed as having segmental paresis and visceral neuropathy associated with herpes zoster infection. Infected lesions were considered more extensive than clinically expected in herpes zoster, affecting the posterior horn or anterior horn. Seven cases of segmental paresis of the abdominal musculature have been reported (1-7). Visceral neuropathy causes urinary retention or colonic pseudo-obstruction (8, 9). A single case was reported which simultaneously involved the sensory, somatic motor, and visceral nervous systems (10). Constipation could be caused by zoster virus in the muscularis propria and myenteric plexi of the colon (11).