Caudal block with steroid in the treatment of acute voiding dysfunction and pain caused by sacral herpes zoster A case report

Rationale: Herpes zoster (HZ) involving sacral dermatome is very rare, which can sometimes cause voiding dysfunction. Patient concerns: A 52-year-old man presented with acute pain and voiding dysfunction, following HZ in his right sacral dermatomes. Diagnoses: Twenty two days before presentation HZ occurred and 9 days after the onset of the HZ, he had trouble with starting urination and weak urine stream which was managed with tamsulosin 0.4 mg orally once a day and intermittent urinary catheterization. He was treated with 150 mg of pregabalin 2 times a day, tramadol 50 mg 2 times, and acetaminophen 600 mg 2 times a day. However, his pain intensity was 5 on the numerical analogue scale (NRS) from 0 (no pain) to 10 (worst pain imaginable). Interventions: Fluoroscopy guided caudal block was performed with a mixture of 0.5% lidocaine 10 mL and triamcinolone 40 mg. Outcomes: One day after the procedure, the pain decreased to 1 on the NRS score. In addition, voiding difficulty greatly improved. Three days after the intervention, the patient reported complete resolution of pain and voiding dysfunction. He currently remains symptom free at a 3-month follow-up. Lessons: A caudal block with steroid can be an effective option for treatment of acute voiding dysfunction and pain following sacral HZ.