An Atypical Presentation of Post-herpetic Neuralgia and Bell’s Palsy in a Diabetic Patient: A Case Report

TL;DR

A diabetic patient developed post-herpetic neuralgia and Bell’s palsy, showing the challenges in diagnosing and treating this condition.

Contribution

Highlights an atypical PHN case in a diabetic patient and the effectiveness of valacyclovir treatment.

Findings

PHN and Bell’s palsy occurred together in a patient with type 2 diabetes.

Valacyclovir provided significant relief after initial gabapentin treatment.

Early and targeted intervention is crucial for managing PHN in complex cases.

Abstract

Post-herpetic neuralgia (PHN) is a severe and often persistent complication of varicella-zoster virus (VZV) reactivation, particularly affecting the elderly and immunocompromised. We present the case of a 54-year-old male with a history of childhood chickenpox and type 2 diabetes mellitus who developed PHN following VZV reactivation. Initial symptoms of burning and painful paresthesia in the shoulders, combined with the subsequent onset of Bell's palsy, confirmed the diagnosis of PHN. Beginning with an initial treatment of gabapentin, significant relief was ultimately achieved with valacyclovir, emphasizing the importance of early and targeted intervention in PHN management. This case underscores the complexities of diagnosing PHN, especially in the presence of comorbidities, and highlights the need for further research to refine treatment strategies for this debilitating condition.

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