Abstract

Background: Herpes zoster (HZ) is a vesicular eruptive disease affecting the skin and peripheral nerves due to the reactivation of the Varicella Zoster Virus (VZV). VZV reactivation can cause neuropathy and vesicular skin lesions distributed according to nerve dermatomes. Rarely encountered neuropathy of the enteric nervous system can take the form of intestinal pseudo-obstruction with clinical features of paralytic ileus. We report a case of HZ with a clinical picture resembling paralytic ileus which, if treated late, will increase the morbidity and mortality of the sufferer. Case Presentation: A 59-year-old man came to the hospital emergency room with complaints of abdominal hardness, wall tension, pain, and inability to fart and defecate followed by plentiful water contents from the abdomen to the right back. Physical examination showed decreased bowel sounds and eruption of vesicular lesions with erythematous skin base distributed dermatomal T8-10 dextra. Blood tests showed elevated monocytes and hyperglycemia, while abdominal radiology showed dilated colon and normal air distribution in the colon. Tzanck's test revealed multinucleated giant cells. The patient was diagnosed with HZ and showed improvement after being given orally acyclovir and gabapentin. Summary: Neuropathy of the enteric nervous system due to VZV infection needs to be considered in the paralytic ileus clinical manifestation accompanied by vesicular skin lesions pathognomonic for HZ