Impending Diabetic Ketoacidosis after Epidural Steroid and Local Anesthetics Administration for Herpes Zoster with Deafferentation Pain of a Diabetic Patient-A Case Report

Abstract

Postherpetic neuralgia (PHN) is the most complication of Herpes zoster (HZ) and one of the most intractable neuropathic pains. The use of corticosteroids with or without other concomitant therapy for HZ and PHN is not guaranteed. Previous studies showed that epidural injection of steroids and local anesthetics or/and antiviral therapy in acute phase of herpes zoster is a promising therapy for reductions in the use of analgesics, the time to uninterrupted sleep, the time to resumption of usual activities ,and prevention of PHN. However, Corticosteroid therapy is seldom used in patients at risk for corticosteroid-induced toxicity (e.g., patients with diabetes mellitus or gastritis) and makes a restriction for these patients. We present a case of 67-year-old female patient with the history of diabetes mellitus who presented with impending diabetic ketoacidosis (DKA) 8 days after receiving 40 mg triamcinolone into the epidural space for prevention of PHN and relief of HZ with deafferentation pain. Further investigations of metabolic and endocrine sequelae of epidural corticosteroid, association between diabetic patient and the use of epidural steroid and the strategies of treatment and prevention of postherpetic neuralgia will be beneficial for clinicians in helping this kind of patients who suffered from this problem.