Reactions 1916, p369 - 23 Jul 2022 1

Prednisone/pregabalin/tramadol S

Elsberg syndrome and lack of efficacy: case report

A 74-year-old woman developed Elsberg syndrome (ES) during treatment with prednisone for herpes zoster (HZ). Later, she
exhibited lack of efficacy during treatment with pregabalin and tramadol for ES [not all routes stated].
The woman was admitted with a 1-week history of constipation and bladder dysfunction and a 3-week history of pain in sacral
area and rash. Three weeks prior to her current admission, she was diagnosed with HZ and started receiving prednisone 15mg once
a day, mecobalamin, indometacin [indomethacin] and famciclovir. A week prior to her current admission, she experienced
constipation, frequent urination, incomplete bladder emptying and numbness in perianal region. Her medical history was significant
for hyperlipidaemia and hypertension under unspecified medications. Upon admission, vital signs showed BP 164/75mm Hg, HR
65 beats/min, RR 18 breaths/min and temperature 36.4°C. Physical examination revealed hypoaesthesia in the perianal region along
with numerous clusters of erythematous vesicles in the left sacral region. Urine test indicated WBC (++) and urodynamic tests
showed detrusor areflexia. Based on these findings, she was diagnosed with ES. It was reported that prednisone could increase the
risk of HZ developing into ES [duration of treatment to reaction onset not stated].
On day 2 of admission, the woman underwent urethral catheterisation along with anti-infective therapy with IV cefoperazone/
sulbactam [Sulperazon], laxative therapy with lactulose and analgesic therapy with oral tramadol 50mg twice a day and oral
pregabalin 75mg once a day. On day 9 of her admission, her constipation symptoms showed gradual improvement; thus,
medication intervention with lactulose was no longer required. Thereafter, she was unable to remove the bladder catheter. The
conventional therapy with pregabalin and tramadol, was also found to be ineffective. Therefore, she started undergoing
electroacupuncture (EA). After 3 sessions, pain in the sacral area was released and bladder catheter was removed, so that she could
achieve spontaneous urination. She was then discharged from the hospital and all drugs were suspended. However, neuralgia,
numbness and difficulties voiding in the sacral area, causing difficulty in sitting on a chair without a cushion, indicating treatment
inefficacy. Thus, three more sessions of EA were conducted and she showed complete recovery with the disappearance of pain and
numbness in the sacral region. A 3-month and 12-month follow-up showed complete relief and no recurrence of condition.
Yang L-S, et al. Acupuncture for the Elsberg Syndrome Secondary to Varicella-Zoster Virus Infection: a Case Report and Brief Review. Journal of Acupuncture and Meridian
Studies 15: 152-156, No. 2, Jan 2022. Available from: URL: http://www.journals.elsevier.com/journal-of-acupuncture-and-meridian-studies/ 803685686

0114-9954/22/1916-0001/$14.95 Adis © 2022 Springer Nature Switzerland AG. All rights reserved Reactions 23 Jul 2022 No. 1916