About 30% of patients with CLL get shingles. Shingles is cause by the chicken pox virus that lays dormant in nerves after a childhood attack. When your immunity falls the virus breaks out again and migrates down a nerve to cause a blistering rash on the area of skin supplied by that nerve. It is usually very painful. If it is caught early with high doses of antiviral the attack can be shortened and recovery ios full. But antivirals do not work if given to late (some people say after 48 hours) or in too small a dose. We used to give acclovir in hospital by a drip, though now the newer drugs like famcyclovir can be given orally.

Motor shingles, when the virus affects the power in the muscles rather than the sensation in the skin, is very rare. I have seen it twice in CLL patients. In the two I saw it eventually got better but took several months. Some patients with shingles have persistent pain that is very difficult to treat. Anti-convulsants like carbamazapine and anti-depressants like amitriptylline have their advocates, but the usual analgesics do not work.

I have seen three patients who developed Parkinson's disease after shingles. This is obviously very rare and may be just a coincidence. If anyone on the list has had this complication I would be interested to know.