Herpes Zoster-Associated Urinary Retention Can Cause Serious Complications

A newly published case report emphasizes the importance of caregivers monitoring for herpes zoster-associated urinary system dysfunction. The report, published in Infection and Drug Resistance, notes that a considerable amount of total herpes zoster cases involve infection in the sacral area.

The report authors wrote that although cases of acute urinary retention (AUR) and defecation disorders caused by herpes zoster infection in the sacral area have been reported, there were previously no clinical cases reported about spontaneous bladder rupture. However, in the published case report, the investigators described a male patient, 77 years of age, who experienced severe complications from spontaneous bladder rupture caused by herpes zoster-associated urinary retention.

Herpes zoster is caused by reactivated latent varicella-zoster virus. Incidence of the infection in the sacral area comprises 8% of all herpes zoster infections, according to the study authors. This condition can lead to urinary system complications, especially in elderly and immunocompromised patients.

Despite prior reports of AUR and defecation issues caused by herpes zoster infection in the sacral area, cases of spontaneous bladder rupture, which is a rare emergency, have yet to be clinically reported.

The patient had a 10-year history of hypertension and type 2 diabetes. A week before being admitted to the emergency department, he was administered antiviral, analgesic, and nutritional nerve treatment for herpes zoster infection in the sacral area.

The patient received 0.3 g of valacyclovir hydrochloride orally twice daily, 0.25 g of diflunisal dispersible tablets orally twice daily, and 0.5 mg of methylcobalamin orally 3 times daily. Hours before admission, he began suffering from abdominal pain, obvious abdominal distention, and slight shortness of breath. He also had trouble urinating and defecating for 4 days but had no prior history of trauma.

A physical examination showed that patient was apyretic, with a distended and painful abdomen, especially in the hypogastric area, with guarding and rebound tenderness, and massive ascites. The patient also had an enlarged prostate with no palpable nodule.

Abdominal computer tomography showed a large amount of effusion in the abdomen and pelvis, as well as large amounts of contents in the colon, and a suspected bladder breach. A blood test showed elevated inflammatory indexes and a blood gas analysis showed hypoxemia and metabolic acidosis with hyperkalemia.

After admission to the intensive care unit, the patient was diagnosed with an intraperitoneal bladder rupture. While operating, a 2 cm laceration was found in the bladder wall connected to the abdominal cavity. Physicians subsequently performed a bladder repair and cystostomy.

The study authors noted that spontaneous bladder rupture has an approximately 50% mortality rate. The most common causes of rupture are malignant tumors, pelvic penetrating radiotherapy, chronic bladder infection or inflammation, neurogenic bladder, bladder diverticulum, and bladder outlet obstruction, according to the investigators.

However, in this case report, the bladder rupture was apparently caused by AUR from the herpes zoster infection in the sacral area and increased bladder pressure. The authors noted AUR may be explained by the spread of the infection into the peripheral nerves.

The patient was able to regain complete bladder function following surgery to repair his bladder and treatment with antiviral drugs.

“The risk of herpes zoster-associated urinary system dysfunction cannot be ignored. Urgent intervention is required for the acute urinary retention caused by herpes zoster infection in the sacral area,” the study authors concluded.

Reference

Huang J, Tai S, Ding H, Xu L, Hua R, Yu Y, Mao D. A Rare Case of Spontaneous Bladder Rupture in a Herpes Zoster Patient. Infect Drug Resist. 2022;15:5193-5196
https://doi.org/10.2147/IDR.S380752