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Syndrome of Inappropriate Secretion of Antidiuretic Hormone Associated with Localized Herpes Zoster Ophthalmicus

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Abstract

The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) associated with localized herpes zoster is rarely reported and may be under-appreciated. We describe two diabetic men with herpes zoster ophthalmicus (HZO) who developed hyponatremia (114 and 116 mmol/L) during acute illness. Both were euvolemic and had elevated urine osmolality (435 and 368 mmol/kg.H2O) and sodium (Na+) concentration (61 and 63 mmol/L) along with normal cardiac, renal, liver, and endocrine function consistent with the diagnosis of SIADH. Thorough investigation for other causes of SIADH, including detailed physical examination, laboratory studies, and computed tomography of the brain, chest, and abdomen, were negative. Despite antiviral therapy (acyclovir) for herpes zoster, ophthalmoplegia, keratitis, and post-herpetic neuralgia (PHN) developed. Even with fluid restriction and high salt diet, SIADH lasted for 3 to 4 months and resolved concomitantly with resolution of PHN, suggesting an association between SIADH and HZO. These two cases raise the potential for herpes zoster infection, especially HZO, to involve the regulatory pathway of ADH secretion, contributing to SIADH. The presence of PHN, which reflects greater neural damage may, at least in part, explain the prolonged ADH secretion and hyponatremia.

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Authors and Affiliations

  1. Division of Nephrology, Department of Medicine, Tri-Service General Hospital, Taipei, Taiwan, Republic of China

    Chih-Chiang Wang MD & Shih-Hua Lin MD

  2. Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China

    Jiann-Tomg Chen MD, PhD

  3. Division of Nephrology, Department of Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan, Republic of China

    Chih-Chiang Wang MD & Jeng-Chuan Shiang MD

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  1. Chih-Chiang Wang MD
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  2. Jeng-Chuan Shiang MD
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  3. Jiann-Tomg Chen MD, PhD
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  4. Shih-Hua Lin MD
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Correspondence to Shih-Hua Lin MD.

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Wang, CC., Shiang, JC., Chen, JT. et al. Syndrome of Inappropriate Secretion of Antidiuretic Hormone Associated with Localized Herpes Zoster Ophthalmicus. J GEN INTERN MED 26, 216–220 (2011). https://doi.org/10.1007/s11606-010-1517-4

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  • DOI: https://doi.org/10.1007/s11606-010-1517-4

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