Published online Jan 14, 2022. doi: 10.12998/wjcc.v10.i2.717
Peer-review started: August 18, 2021
First decision: November 1, 2021
Revised: November 11, 2021
Accepted: December 11, 2021
Article in press: December 11, 2021
Published online: January 14, 2022
Processing time: 146 Days and 12.4 Hours
Varicella-zoster virus (VZV) generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves. Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment, leading to skin manifestations (herpes zoster). Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis, encephalitis, and myelitis. One such case is described in this study.
A 64-year-old man presented with dysuria, pyrexia, and progressive disturbance in consciousness. He had signs of meningeal irritation, and cerebrospinal fluid (CSF) analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64. Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes. He had four isolated blisters with papules and halos on his right chest, right lumbar region, and left scapular region. Infected giant cells were detected using the Tzanck test. Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy. Serum VZV antibody titers suggested previous infection, and the CSF tested positive for VZV-DNA. He developed paraplegia, decreased temperature perception in the legs, urinary retention, and fecal incontinence. The patient was diagnosed with meningitis, encephalitis, and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days. Despite gradual improvement, the urinary retention and gait disturbances persisted as sequelae.
VZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.
Core Tip: We describe a rare case of multiple central nervous system (CNS) complications following varicella zoster virus (VZV) reactivation in an immunocompetent patient with mild diabetes. He had four isolated blisters with encephalitis, meningitis, and myelitis. VZV reactivation should be considered in the differential diagnosis of patients with sporadic blisters and unexplained CNS symptoms.