Elsberg Syndrome in Pregnancy: A Case of Acute Urinary Retention Due to Sacral Myeloradiculitis Resulting From a Recurrent Herpes Simplex Virus-2 Infection

Abstract Background: Urinary retention occurs in 2% of primary Herpes Simplex Virus (HSV) outbreaks, due either to the exquisite pain with voiding or to a sacral nerve radiculopathy causing detrusor areflexia. There are almost no reported cases, however, of urinary retention during a recurrent HSV outbreak in pregnancy. Case Presentation: We present the case of a 23 year old female, gravida 1, para 0, diagnosed with acute urinary retention at 18 weeks gestational age. She presented with suprapubic abdominal pain and complete inability to void. Labs obtained three days earlier for a painful genital lesion were notable for positive HSV-2 viral culture and HSV-2 IgG serology. HSV-2 IgM and HSV-1 serologies were negative. She was treated with oral valcyclovir and an indwelling Foley catheter. Complex cystometrics revealed detrusor areflexia. Two weeks later, she was able to void via Valsalva maneuver. Her symptoms completely resolved within four weeks of initial presentation. Conclusions: Elsberg Syndrome, a self-limiting syndrome of acute urinary retention in combination with other signs of spinal cord dysfunction, is commonly caused by HSV. Recurrent HSV as the cause of Elsberg Syndrome has only been reported in two other patients, both of whom had recurrent HSV meningitis. In our patient, a recurrent HSV-2 outbreak without prior history of HSV meningitis led to detrusor areflexia and subsequent urinary retention which resolved within four weeks. Elsberg Syndrome due to recurrent HSV should be considered in the differential diagnosis of acute urinary retention in pregnancy.