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LETTER TO EDITOR
Year : 2019  |  Volume : 10  |  Issue : 3  |  Page : 143-144

Shingles near surgical site: A rare complication in a diabetic following hip arthroplasty


1 Department of Orthopaedics, Government Medical College, Haldwani, Uttarakhand, India
2 Department of Pathology, Government Medical College, Haldwani, Uttarakhand, India

Date of Web Publication27-Aug-2019

Correspondence Address:
Dr. Ganesh Singh Dharmshaktu
Department of Orthopaedics, Government Medical College, Haldwani - 263 139, Uttarakhand.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jod.jod_41_18

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How to cite this article:
Dharmshaktu GS, Pangtey T. Shingles near surgical site: A rare complication in a diabetic following hip arthroplasty. J Diabetol 2019;10:143-4

How to cite this URL:
Dharmshaktu GS, Pangtey T. Shingles near surgical site: A rare complication in a diabetic following hip arthroplasty. J Diabetol [serial online] 2019 [cited 2019 Sep 16];10:143-4. Available from: http://www.journalofdiabetology.org/text.asp?2019/10/3/143/265416



Dear Editor,

Shingles, an infection with herpes zoster virus (HZV), is a reactivation of varicella zoster virus infection long after primary infection and presents usually as a self-limiting disorder in elderly or those with compromised immunity. It presents acutely with varying degrees of painful blisters and rash affecting dermatomal distribution.[1] The worrisome aspect of it is that it may persist as post-herpetic neuralgia with disabling pain. Its presence in unexposed body parts and in unsuspected location requires careful clinical evaluation.

A 60-year-old male patient presented to us with history of acute pain over right hip region for the last 1 week. He was a known diabetic for the last 8 years on oral hypoglycaemic medication. He had history of total hip arthroplasty done on the right side 1 year back with no major related complication noted so far. Following the acute severe pain, he was sceptic of some underlying infection or problem with implant and wished for investigations to rule out the same. He took pain medication for 2 days but got minimal relief. He was advised complete blood counts, C-reactive protein, erythrocyte sedimentation rate among other routine tests along with radiograph of hip region. There was no history of injury and fever, while the past history about operation was also uneventful. The blood reports were unremarkable except higher blood sugar level suggestive of uncontrolled diabetes and the radiographs showed well-fixed implant without any significant abnormality. The inflammatory markers, liver and renal function tests, were within normal limits. The clinical examination of the affected area revealed an area of skin lesion over gluteal region extending to the posterior mid-thigh of the right side [Figure 1]. The patient, however, recalled, on further history taking, about small blisters over the area a week ago that he thought as not significant and unrelated to present problem. The lesion appeared characteristic to healing shingles as some of the vesicles were scabbing accompanied by excruciating localised pain. On the clinical basis, diagnosis of shingles or HZV infection over sciatic distribution area was made. He was managed with oral acyclovir for a week to dramatic clinical improvement as the lesion healed well over 5 weeks. There was no post-herpetic neuralgia noted in the follow-up. The modification in dosage of anti-diabetic medicines was ensured all through the treatment corresponding to regular blood sugar levels. The compliant and supervised treatment led to uncomplicated recovery and also ensured no default of pharmacotherapy or recurrence of the disorder.
Figure 1: The characteristic healing rash over right buttock region with gluteal wasting following operation (above). The incision site is lateral and beyond the skin lesion. The lesion following sciatic nerve distribution till middle of thigh (below)

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The diabetes, especially type 1, have been reported to have increased susceptibility to HZV infection.[2] There is, however, only one report of similar presentation over sciatic nerve distribution following double arthroplasty in a 75-year-old woman.[3] This short case snippet highlights importance of astute clinical assessment and proper history taking to suspect uncommon disorders in common clinical settings. The acute pain over surgical site may not always denote deep sinister infection and uncommon viral exanthem may at times coexist. Prompt diagnosis may save unnecessary investigation for deep surgical site infection and also lessen the chances of developing painfully disabling post-herpetic neuralgia.

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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Cohen JI. Clinical practice: Herpes zoster. N Engl J Med 2013;369:255-63.  Back to cited text no. 1
    
2.
Chen HH, Lin IC, Chen HJ, Yeh SY, Kao CH. Association of herpes zoster and type 1 diabetes mellitus. PLoS One 2016;11:e0155175.  Back to cited text no. 2
    
3.
Park KS, Yoon TR, Kim SK, Park HW, Song EK. Acute postoperative herpes zoster with a sciatic nerve distribution after total joint arthroplasty of the ipsilateral hip and contralateral knee. J Arthroplasty 2010;25:497.e11-5.  Back to cited text no. 3
    


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