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24 Letters to the editor / Joint

ltrasonic strain-rate imaging. Peak systolic strain rate and strainalues are reduced in a number of myocardial pathologies. Weay conclude that the localized reduction in myocardial strain

eflects the regional myocardial fibrosis [9,10].We suggest that regional vasculitis may be the pathological

echanism underlying the isolated cardiac septum involvementbserved in our case.

ppendix A. Supplementary material

Supplementary material (Fig. S1) associated with this arti-le can be found at http://www.sciencedirect.com, at doi:10.016/j.jbspin.2009.03.009.

eferences

[1] Churg J, Strauss L. Allergic granulomatosis, allergic angiitis, and periar-teritis nodosa. Am J Pathol 1951;27:277–331.

[2] Noth I, Strek ME, Leff AR. Churg-Strauss syndrome. Lancet2003;361:587–94.

[3] Pelà G, Tirabassi G, Pattoneri P, et al. Cardiac involvement in theChurg-Strauss Syndrome. Am J Cardiol 2006;97:1519–24.

[4] Masi AT, Hunder GG, Lie JT, et al. The American College of Rheumatology1990 criteria for the classification of Churg-Strauss syndrome (allergicgranulomatosis and angiitis). Arthritis Rheum 1990;33:1094–100.

[5] Nataraja A, Mukhtyar C, Hellmich B, et al. Outpatient assessment of sys-temic vasculitis. Best Pract Res Clin Rheumatol 2007;21:713–32.

[6] Parrillo JE, Borer JS, Henry WL, et al. The cardiovascular manifestationsof the hypereosinophilic syndrome. Prospective study of 26 patients, withreview of the literature. Am J Med 1979;67:572–82.

[7] Petersen SE, Kardos A, Neubauer S. Subendocardial and papillary muscleinvolvement in a patient with Churg-Strauss syndrome, detected by contrastenhanced cardiovascular magnetic resonance. Heart 2005;91:e9.

[8] Tai PC, Holt ME, Denny P, et al. Deposition of eosinophil cationic proteinin granulomas in allergic granulomatosis and vasculitis: the Churg-Strausssyndrome. Br Med J (Clin Res Ed) 1984;289:400–2.

[9] Rosato E, Maione S, Vitarelli A, et al. Regional diastolic function by tissuedoppler echocardiography in systemic sclerosis: correlation with clinicalvariables. Rheumatol Int 2008, doi:10.1007/s00296-008-0827-x.

10] Weidemann F, Niemann M, Herrmann S, et al. A new echocardiographicapproach for the detection of non-ischaemic fibrosis in hypertrophicmyocardium. Eur Heart J 2007;28:3020–6.

Edoardo Rosato a

Antonio Vitarelli b

Simonetta Pisarri a

Felice Salsano a,∗a Clinical Immunology and Allergy Unit, Department of

Clinical Medicine, Sapienza University of Rome, 37, Vialedell’Universita, 00185 Rome, Italy

b Department of Cardiovascular Sciences, Sapienza Universityof Rome, Rome, Italy

∗ Corresponding author.E-mail address: felice.salsano@uniroma1.it

(F. Salsano).

24 March 2009

Available online 30 October 2009

oi:10.1016/j.jbspin.2009.03.009

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Spine 76 (2009) 718–725

oster cruralgia in a pregnant woman

eywords: Cruralgia; Herpes zoster; Pregnancy

We described here the case of a 31-year-old pregnant womant 17 weeks of amenorrhea. She was admitted to our departmentith intense pain on the anterior part of the left lower extremity,hich started 3 days before admission. The clinical examinationid not show any motor deficiency but hypoesthesia was evident.he patellar reflex was present. Her back was slightly painful.iological test results were normal. The ultrasound scan did not

how any venous thrombosis. No abnormalities were seen onumbar magnetic resonance image nor on hip ultrasound scan.etal vitality was normal. With a possible diagnosis of cru-algia, the patient was given a corticosteroid infusion withoutfficiency. Two days later (six days after the first symptoms), sheeveloped a vesicular rash where the pain was localized, highlyuggestive of zona (fig. S1; see the supplementary material asso-iated with this article online). Polymerase chain reaction on thekin positively indicated the Varicelle-Zoster Virus. Valacycloviras started. Rash lesion improved and pain decreased.During pregnancy, many female patients suffer from back

ain and lower limb radiculalgia. The gravid uterus weighspproximately 1 kg added to the average infant birth weight of 3o 3.6 kg. Direct pressure on nerve roots and ischemia of neurallements, due to uterine pressure on aorta and vena cava, mayesult in radiculalgia. Moreover, the approximate frequency oferniated disc disease is estimated to be one in 10,000 preg-ancies [1]. Hyperemesis gravidarum in the first trimester canlso exacerbate preexisting disc disease [2]. Exceptionally, ver-ebral fractures, related to pregnancy-associated osteoporosis,ave been reported explaining back pain and radiculalgia [3,4]s well as an acute thrombosis of inferior vena cava [5].

With this patient, the cruralgia was due to herpes zoster infec-ion. In most cases, neurological complications of herpes zosterccur coincidentally with an acute eruption or even months afterhe rash has resolved. However, in a few cases, sciatica precedeshe skin lesions. Radiculalgia with motor loss has also been seenn 1 to 5% of cases [6].

Herpes zoster during pregnancy is rare. Unlike varicella, itoes not seem to pose a risk of congenital infection, irrespec-ive of the time between herpes zoster and birth [7]. Pregnancyas no effect on the course of herpes zoster. Valacyclovir cane used during pregnancy. The indications for antiviral therapyorrespond with those of other adults [8].

ppendix A. Supplementary data

Supplementary material (Fig. S1) associated with thisrticle can be found at http://www.sciencedirect.com, atoi:10.1016/j.jbspin.2009.04.008.

eferences

1] La Ban MM, Perrin JCS, Latimer FR. Pregnancy and herniated lumbar disc.Arch Phys Med Rehabil 1983;64:319–21.

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Letters to the editor / Joint

2] Garmek SH, Guzelian GA, D’Alton JG, et al. Lumbar disk disease in preg-nancy. Obstet Gynecol 1997;89:821–2.

3] Khovidhunkit W, Epstein S. Osteoporosis in pregnancy. Osteoporos Int1996;6:345–54.

4] Smith R, Phillips AJ. Osteoporosis during pregnancy and its management.Scand J Rheumatol Suppl 1998;107:66–7.

5] Gormaus N, Ustun ME, Paksoy Y, et al. Acute thrombosis of inferior venacava in a pregnant woman presenting with sciatica: a case report. Ann VascSurg 2005;19:120–2.

6] Merchut MP, Gruner G. Segmental zoster paresis of limbs. ElectromyogrClin Neurophysiol 1996;36:369–75.

7] Enders G, Miller E, Cradock-Watson J, et al. Consequences of varicella

and herpes zoster in pregnancy: prospective study of 1739 cases. Lancet1994;343(8912):1548–51.

8] Kempfa SW, Meylanb P, Gerberc S, et al. Swiss recommendations forthe management of varicella zoster virus infections. Swiss Med Wkly2007;137:239–51.

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Spine 76 (2009) 718–725 725

Claire Immediato Daïen 1,∗Jean-David Cohen 1

Christian JorgensenService d’immunorhumatologie clinique,

hôpital Lapeyronie, 371, avenue du Doyen-Gaston-Giraud,34295 Montpellier cedex 5, France

∗ Corresponding author. Tel.: +04 67 33 72 31;fax: +04 67 33 72 27.

E-mail address: immeclair@hotmail.com (C.I. Daïen).1 These authors contributed equally to this article.

2 April 2009

Available online 27 November 2009

oi:10.1016/j.jbspin.2009.04.008