pISSN 2005-9159
eISSN 2093-0569

Review Article

Korean J Pain 2020; 33(3): 208-215

Published online July 1, 2020 https://doi.org/10.3344/kjp.2020.33.3.208

Copyright © The Korean Pain Society.

Zoster sine herpete: a review

Junli Zhou1 , Juan Li1 , Lulin Ma1 , Song Cao1,2

1Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, Zunyi, China
2Guizhou Key Laboratory of Anesthesia and Organ Protection, Zunyi Medical University, Zunyi, China

Correspondence to:Song Cao
Department of Pain Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Street, Zunyi 563000, Guizhou, China
Tel: +8618212170434
Fax: +860851-28608835
E-mail: caosong4321@163.com

Received: April 6, 2020; Revised: May 30, 2020; Accepted: June 2, 2020

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Zoster sine herpete (ZSH) is one of the atypical clinical manifestations of herpes zoster (HZ), which stems from infection and reactivation of the varicella-zoster virus (VZV) in the cranial nerve, spinal nerve, viscera, or autonomic nerve. Patients with ZSH display variable symptoms, such as neuralgia, however, different from HZ, ZSH show no zoster, which makes clinical diagnosis difficult. ZSH not only causes initial symptoms, such as neuropathic pain in the affected nerve, Bell palsy, and Ramsay Hunt syndrome, but also postherpetic neuralgia and fatal complications such as VZV encephalitis and stroke. The misdiagnosis of ZSH and tardy antiviral treatment may lead to severe ZSH sequelae. We review the publications related to ZSH, especially its diagnosis with VZV DNA and/or anti-VZV immunoglobulin (IgG and IgM). More work about ZSH, especially ZSH epidemiological survey and guidelines for its diagnosis and treatment, are needed because most of the present studies are case reports.

Keywords: Antiviral Agents, Diagnosis, Herpes Zoster, Herpesvirus 3, Human, Infections, Neuralgia, Postherpetic, Therapeutics, Virus Diseases, Zoster Sine Herpete.