A 63-year-old man was admitted to our hospital because of aspiration pneumonia. The patient had long-standing progressive supranuclear palsy (PSP) with dysphagia and he had had placement of percutaneous endoscopic gastrostomy (PEG). After the treatment of aspiration pneumonia, the patient received a rehabilitation program for dysphagia and disuse syndrome during hospitalization. On day 52, the patient suddenly developed intractable and persistent hiccups without other symptoms or physical signs, including vital signs. Two days later, a group of vesicles with surrounding erythematous lesions were identified on the ophthalmic division (V1) of the left trigeminal nerve. Thereafter, extensive scattering blisters appeared on the trunk. Serologic test showed significantly elevated IgM antibody against varicella zoster virus. The patient received a diagnosis of disseminated herpes zoster. After he had the treatment with intravenous acyclovir, both the skin lesions and hiccups disappeared promptly.
Hiccups are myoclonic, synchronous and involuntary contractions of the diaphragm, which are immediately followed by laryngeal closure. Etiologic list of hiccups is broad but it is usually a self-limited condition. Our patient developed hiccups as an early symptom before manifesting disseminated herpes zoster. Among the previous case reports with hiccups and zoster, the latency periods between hiccups and the onset of zoster eruption are variable. The reported distributions of zoster skin lesions are also variable such as on the neck, trunk or leg. Our patient developed hiccups two days prior to the appearance of vesicles with disseminated lesions. To our knowledge, this is the first case of disseminated herpes zoster presenting with hiccups as a prodrome. Persistent hiccups can be a rare early manifestation of generalized herpes zoster.
Although there are many reported causes of hiccups, our case suggested that persistent hiccups could be a rare prodrome for generalized herpes zoster. In patients with persistent hiccups, skin examination with careful follow-up might be the key for making this diagnosis.
To cite this abstract:Kamei Y, Mori T, Kobayashi M, Hibi A, Chishima I, Komagamine J, Yabuki T, Adachi T, Uehara K, Kato T, Matsumoto K, Tokuda Y. Skin Hiccups. Abstract published at Hospital Medicine 2015, March 29-April 1, National Harbor, Md. Abstract 560. Journal of Hospital Medicine. 2015; 10 (suppl 2). https://www.shmabstracts.com/abstract/skin-hiccups/. Accessed April 4, 2020.