Abstract
This is a report of a middle-aged female patient on hemodialysis (for diabetic nephropathy) suffering from a severe burning pain in the anus. The pain was regarded as an unpleasantness following manipulation to remove rock-hard stool. Proctoscopically, a herpes zoster-like lesion was observed in the right side of the anal canal, innervated by the 5th sacral nerve. The lesion was of tiny vesicular papules which bled easily and was diagnosed as either herpes zoster or herpes simplex. The dose of the antiviral drug was halved due to renal failure. Prostaglandin E1 ointment was added. An antidepressant was started in the early phase. The skin lesion healed and the pain disappeared 33 days later. Complement fixation titers for both herpes zoster virus and herpes simplex virus were 16 times 180 days later. Herpes zoster or herpes simplex should be considered in the case of pain in the anus. For visual diagnosis, it is mandatory to observe the anus as far as the dentate line.
