Dermatology: Practical and Conceptual


Image Letter  |  Dermatol Pract Concept 2021;11(1):e2020096 1

Dermatology Practical & Conceptual

Case Presentation 

An otherwise healthy 49-year-old man presented to the 

emergency department with complaint of a 3-day history 

of abdominal bulging (Figure 1A) in the same location of a 

previous herpes zoster infection. The bulge increased with 

Valsalva maneuver. Skin examination still revealed residual 

lesions of herpes zoster (Figure 1B). The final diagnosis was 

postherpetic pseudohernia, and at the 3-month follow-up 

visit, it had disappeared.

Teaching Point
Herpes zoster is characterized by clustered maculopapular 

and vesicular lesions along a dermatome as a result of reac-

tivation of varicella zoster virus in the dorsal root ganglia of 

Abdominal Wall Postherpetic Pseudohernia 
Gerald Selda-Enriquez1, Ana Laura Melian-Olivera1, Patricia Burgos-Blasco1,  

Daniel Ortega-Quijano1

1 Servicio de Dermatología, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain 

Key words: postherpetic pseudohernia, herpes zoster, infectious disease, dermatology

Citation: Selda-Enriquez G, Melian-Olivera AL, Burgos-Blasco P, Ortega-Quijano D. Abdominal wall postherpetic pseudohernia. Dermatol 
Pract Concept. 2021;11(1):e2020096. DOI: https://doi.org/10.5826/dpc.1101a96

Accepted: June 8, 2020; Published:  December 10, 2020

Copyright: ©2020 Selda Enriquez et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 
License BY-NC-4.0, which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original 
author and source are credited.

Funding: None.

Competing interests: The authors have no conflicts of interest to disclose.

Authorship: All authors have contributed significantly to this publication.

Corresponding author: Gerald Selda-Enriquez, MD, Servicio de Dermatología, Hospital Universitario Ramón y Cajal, Carretera Colmenar 
Viejo km 9.100, 28034 Madrid, Spain. Email: geraldselda@gmail.com

Figure 1. (A) Bulging is seen in the right abdomen. (B) Erythematous maculopapular lesions due to herpes zoster are observed along the right 

T9-10 dermatome, consistent with the area where bulging is seen.

A B



2 Image Letter  |  Dermatol Pract Concept 2021;11(1):e2020096

References

1.  Healy C, McGreal G, Lenehan B, McDermott EW, Murphy JJ. 

Self-limiting abdominal wall herniation and constipation follow-

ing herpes zoster infection. QJM. 1998;91(11):788‐789. DOI: 

10.1093/qjmed/91.11.788. PMID: 10024942.

2. Yoo J, Koo T, Park E, et al. Abdominal pseudohernia caused by 

herpes zoster: 3 case reports and a review of the literature. JAAD 

Case Rep. 2019;5(8):729–732. DOI: 10.1016/j.jdcr.2019.06.019. 

PMID: 31440570. 

peripheral nerves. An infrequent complication is postherpetic 

pseudohernia which arises when the anterior root ganglia is 

involved, thus provoking muscular paralysis [1]. Differential 

diagnosis with true hernia by means of clinical and radiolog-

ical exams is critical, as it does not require surgery and tends 

to disappear spontaneously in the majority of cases after less 

than a year [2].