Elsberg Syndrome due to HSV-2 in Pregnancy

Abstract

Elsberg syndrome is a rare, self-limiting radiculitis, often associated with HSV-2 infection. It typically presents with urinary retention and cauda equina involvement. We report a case of a 37-year-old woman, 36 weeks pregnant, who presented with fever, headache, photophobia, urinary retention, and left-leg numbness. Neurological examination suggested spinal cord involvement, despite an unremarkable magnetic resonance imaging (MRI). Cerebrospinal fluid analysis showed lymphocytic pleocytosis and was positive for HSV-2 by PCR. She was treated with acyclovir for 21 days, leading to clinical improvement. Labor was induced at 38 weeks, resulting in an uncomplicated vaginal delivery. Postpartum follow-up showed persistent mild hypoesthesia but overall recovery. This case highlights an atypical presentation of Elsberg syndrome in pregnancy, emphasizing the importance of multidisciplinary collaboration for timely diagnosis and management. Early antiviral therapy contributed to a favorable outcome for both mother and newborn.