Generic selectors
Exact matches only
Search in title
Search in content
Search in posts
Search in pages
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstract
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Addendum
Announcement
Art & Psychiatry
Article
Articles
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Commentary
Conference Oration
Conference Summary
Continuing Medical Education
Correspondence
Corrigendum
Cosmetic Dermatology
Cosmetology
Current Best Evidence
Current View
Derma Quest
Dermato Surgery
Dermatopathology
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
e-IJDVL
Editor Speaks
Editorial
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Errata
Erratum
Focus
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
General
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
History
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL AWARDS 2015
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Index
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
LETTER TO THE EDITOR - LETTERS IN RESPONSE TO PUBLISHED ARTICLES
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Messages
Miscellaneous Letter
Musings
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News
News & Views
Obituary
Observation Letter
Observation Letters
Oration
Original Article
ORIGINAL CONTRIBUTION
Original Contributions
Pattern of Skin Diseases
Pearls
Pediatric Dermatology
Pediatric Rounds
Perspective
Presedential Address
Presidential Address
Presidents Remarks
Quiz
Recommendations
Regret
Report
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Retraction
Review
Review Article
Review Articles
Revision Corner
Self Assessment Programme
SEMINAR
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Studies
Study Letter
Supplement-Photoprotection
Supplement-Psoriasis
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
SYMPOSIUM - VITILIGO
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Tables
Technology
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapeutics
Therapy
Therapy Letter
View Point
Viewpoint
What’s new in Dermatology
View/Download PDF
Letter To Editor
2007:73:5;352-353
doi: 10.4103/0378-6323.35743
PMID: 17921622

Persistent hiccups: A rare prodromal manifestation of herpes zoster

Belum Viswanath Reddy, Geetanjali Sethi, Asok Aggarwal
 Consultant Dermatologists, Skin Institute and School of Dermatology, 'N' Block, Greater Kailash - I, New Delhi, India

Correspondence Address:
Belum Viswanath Reddy
House No: 8-3-167/K/94, Kalyan Nagar Venture - III, Hyderabad - 500018, Andhra Pradesh
India
How to cite this article:
Reddy BV, Sethi G, Aggarwal A. Persistent hiccups: A rare prodromal manifestation of herpes zoster. Indian J Dermatol Venereol Leprol 2007;73:352-353
Copyright: (C)2007 Indian Journal of Dermatology, Venereology, and Leprology
Figure 1: Herpes zoster over the C3-5 dermatomes; Histopathology (H and E, X400) showing an intraepidermal vesicle (inset), multinucleated giant cells and an inclusion body (IB)
Figure 1: Herpes zoster over the C3-5 dermatomes; Histopathology (H and E, X400) showing an intraepidermal vesicle (inset), multinucleated giant cells and an inclusion body (IB)

Sir,

Herpes zoster (HZ) is a common viral infection that occurs due to the reactivation of dormant varicella zoster virus (VZV) from the dorsal root ganglia. The usual prodromal symptoms of HZ include hyperesthesia, tingling, itching, burning or intense pain in the involved dermatome. However, various other local and systemic symptoms may precede the vesicular eruption. Systemic involvement in the form of fever, lassitude and anorexia can also occur. Motor symptoms such as hiccups occur very rarely in the prodrome of HZ. To date, only three such cases have been reported in literature. [1],[2],[3]

An otherwise healthy 29-year-old male patient presented with a three-day history of unilateral, grouped vesicles over the left side of neck and upper chest. Two days prior to the skin eruption, he developed persistent hiccups which occurred relentlessly (4-6 cycles/ minute). The patient complained of pain and paresthesia at the site, but no constitutional symptoms. He denied history of acid reflux or peptic ulcer disease, abdominal trauma, bowel disturbance or recent intake of any drug. The cutaneous eruption prompted him to consult a dermatologist. Physical examination showed clusters of vesicles, pustules and erosions on an erythematous base that were distributed along the C3, C4 and C5 dermatomes [Figure - 1]. Systemic examination was unremarkable. The complete blood count, liver and renal function tests and serum electrolyte estimations were normal. ELISA for HIV was non-reactive. Tzanck preparations from vesicular lesions revealed characteristic cytopathic changes. The skin biopsy showed an intraepidermal vesicle with multinucleated giant cells containing intranuclear inclusion bodies [Figure - 1]. Treatment with acyclovir (800mg five times a day for 7 days) was initiated. The course was uncomplicated with healing of the cutaneous lesions and resolution of hiccups.

Hiccup is an abrupt, transient involuntary contraction of the inspiratory muscles leading to sudden inspiration that is terminated abruptly by closure of the glottis. The name itself is onomatopoeic and is derived from the characteristic "hic" sound. In 1833, Shortt first recognized the association between hiccups and phrenic nerve irritation. [4] Later, the neural pathways (reflex arc) mediating hiccups were delineated. The afferents travel along with the vagus and phrenic nerve fibres, the pharyngeal plexus (C2-C4) and the sympathetic chain (T6-T12). The phrenic nerve (C3-C5) serves as the efferent pathway. The main centre for hiccups in the central nervous system still remains obscure. Any irritation or stimulation along this reflex pathway can result in hiccups.

The latency period between hiccups and the eruption is variable. Brooks described a case, where HZ, varicella and hiccups occurred in the same patient with the latter preceding the cutaneous lesions by 9 days. [1] The case reported by Efrati developed hiccups 6 days prior to appearance of HZ in the left third to fifth thoracic dermatomes. [2] Recently, Berlin et al. [3] reported the case of a patient with HZ suffering from persistent hiccups since 14 days prior to the onset of skin lesions as compared to 2 days in our patient. The symptoms of the patient improved with valacyclovir. Our patient denied previous episodes of persistent hiccups and did not have any prior gastrointestinal illness. Both the skin lesions and hiccups responded promptly to acyclovir therapy further strengthening this correlation.

Acknowledgement

We thank Dr. Kura Sharath Chandra, MD, MPH (New Jersey, USA) and Dr. H. R.Thimmaiah, MBBS (London, UK) for assisting with the literature search.

References
1.
Brooks WDW. Zoster, hiccup and varicella. Br Med J 1931;2:298-9.
[Google Scholar]
2.
Efrati P. Obstinate hiccup as a prodromal symptom in thoracic zoster. Neurology 1956;6:601-2.
[Google Scholar]
3.
Berlin AL, Muhn CY, Billick RC. Hiccups, eructation, and other uncommon prodromal manifestations of herpes zoster. J Am Acad Dermatol 2003;49:1121-4.
[Google Scholar]
4.
Shortt T. Hiccup. Can Med Assoc J 1934;31:38-41.
[Google Scholar]

Fulltext Views
361

PDF downloads
162
Show Sections