A Case of Herpes Zoster Myelitis: Positive Magnetic Resonance Imaging Finding

Hwang, Youn Mee; Lee, B.I.; Chung, Jaewoo; Ahn, Jong Hyeon; Kim, K.W.; Kim, D.I.

doi:10.1159/000116669

Cited by 19 publications

(8 citation statements)

References 10 publications

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“…In myelitis the detection of varicella zoster virus in CSF has been reported [18]. In other previously reported cases, there was no serological confirmation of HZV infection [21,33]. The spinal cord lesion in our case was on the same side and one segment above the initially affected segment where the vesicular eruptions were recognized.…”

Section: Discussioncontrasting

confidence: 40%

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Acute infectious disorders of the spinal cord and its roots with gadolinium-DTPA enhancement in magnetic resonance imaging

et al. 1996

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We studied three patients with myelomeningoradiculitis caused by Borrelia burgdorferi, herpes zoster virus or cytomegalovirus infection. All patients underwent MRI of the spinal cord with gadolinium-DTPA and showed enhancing lesions of the spinal cord or nerve roots that correlated with clinical signs. Gadolinium-DTPA enhancement may visualize lesions that suggest an inflammation associated with blood-brain-barrier alteration and indicate the diagnosis before serological results are available.

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Section: Discussioncontrasting

confidence: 40%

“…Usually, the results of serological tests are not available in the early stages of the disease, causing diagnostic uncertainty with respect to aetiology [3,20,21,34]. In magnetic resonance imaging (MRI) of the spine, intravenous (i.v.)…”

Section: Introductionmentioning

confidence: 99%

Acute infectious disorders of the spinal cord and its roots with gadolinium-DTPA enhancement in magnetic resonance imaging

et al. 1996

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“…In a detailed report that included post mortem examination of the spinal cord, Hogan et al [10] presented evidence of direct invasion of VZV in a patient with transverse myelitis associated with herpes zoster. Demonstration of the VZV antigen in CSF cells by immunofluorescence or isolation of VZV from the CSF is a confirmative evidence for viral central nervous system infection but it is rarely successful [11].…”

Section: Discussionmentioning

confidence: 99%

Transverse myelitis caused by varicella zoster: case reports

2007

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Transverse myelitis is a group of disorders characterized by focal inflammation of the spinal cord and results in loss of motor and sensory function below the level of injury. Occurrence of this condition during or following varicella infection is uncommon. This report describes two cases of transverse myelitis caused by varicella zoster. Key-Words: Varicella zoster, infection, transverse myelitis. Received Varicella zoster virus (VZV) infection causes a variety of neurologic complications, including post-herpetic neuralgia, polyradiculoneuritis, transverse myelitis, vasculopathy, aseptic menengitis, leukoencephalopathy, dorsal root or cranial nerve ganglionitis, ventriculitis, necrotising angiitis and meningoencephalitis [1,2]. Transverse myelitis has been rarely associated with VZV infection. Onset is acute and occurs shortly after typical cutaneous rash in a dermatomal distribution with the development of paraparesis, sensory loss and sphincter dysfunction [3]. No diagnostic test is completely accurate, since VZV can not usually be isolated from blood or cerebrospinal fluid (CSF) in VZV myelitis. Treatment involves high doses of both steroids and acyclovir. Recovery is usually spontaneous, though fatal cases have been reported [4].We describe two cases of transverse myelitis during and following VZV infection that were proven serologically and neurologically. Case 1A 48-year-old woman was presented to our clinic in April 2003 with the complaints of right leg weakness and urinary incontinence. Two months before, she had experienced a painful vesicular eruption on the lateral side of her left breast. Herpes zoster was diagnosed, and she was treated with a 10-day course of oral acyclovir (800 mg five times daily). In March 2003, she had been admitted to another hospital with paresthesia and weakness in both legs. Magnetic resonance imaging (MRI) of the spinal cord demonstrated lesions of high-signal intensity at C1-2 and T2-3 levels. The lesions appeared to be masses, therefore subtotal laminectomy was performed at T1-3. Histopathologic examination showed perivascular lymphocyte infiltration and reactive gliosis.On admission to our center in April, neurologic examination revealed normal levels of consciousness, cooperation, orientation and showed that all cranial nerves were intact. The patient exhibited 1/5 lower extremity weakness on the right and 3/5 on the left, diminished sensation to pain and light touch below the level of T5 dermatome, and marked loss of vibratory sensation and proprioception in both legs. Deep tendon reflexes were normal in the upper extremities, but decreased in the lower extremities. There was no nuchal rigidity.Laboratory findings for complete blood cell count, liver enzymes, BUN, creatinine, C-reactive protein, erythrocyte sedimentation rate and urinalysis were normal. Serological tests for hepatitis B and C, brucellosis, cytomegalovirus, herpes simplex virus, Epstein-Barr virus, PPD and human immunodeficiency virus were all negative. The serum was positive for anti-VZV antibodies....

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“…This process was disseminated throughout the spinal cord; the fact that the maximum number of lesions was at the T9-10 level was consistent with the clinical sensory level and the autopsy findings, perhaps reflecting the original level of VZV reactivation and entry into the spinal cord. In a recent report, an MRI study of a patient with VZV myelitis following herpes zoster involving the C3-4 dermatomes demonstrated an increased T2-weighted signal throughout the long segments of the spinal cord; the study revealed that the maximum number of lesions were in the cervical region, a finding consistent with those at autopsy [9]. In a retrospective review of this case, the sensory level in correlation with findings on the MRI scan might have been used to suggest the correct diagnosis.…”

mentioning

confidence: 54%

Myelitis Due to Varicella-Zoster Virus in an Immunocompromised Patient Without a Cutaneous Rash

Meylan¹,

Miklóssy²,

Iten³

et al. 1995

Clinical Infectious Diseases

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A 35-year-old iv drug addict initially presented to the hospital in 1989 with Pneumocystis carinii pneumonia, oral thrush, and oral herpes ulcers. He was also infected with the human immunodeficiency virus (HIV). Over the next 3 years, he received therapy with oral zidovudine, aerosolized pentamidine, and oral fluconazole. The patient's immunosuppression progressed; 1 month before his second admission the CD4 cell count decreased to 32/mm 3 , the f32-microglobulin level rose to 6.5 mg/L, and the p24 antigen level rose to 94 pg/mL. Three weeks before his second admission he had a fever (temperature to 38.5°C), headaches, and increased frequency of urination. Several days later, oliguria and bilateral leg weakness were noted; at the time of admission the weakness had progressed to paraplegia, and the patient also had urinary incontinence and intermittent diplopia.Physical examination showed an afebrile, cachectic, dehydrated patient with diminished mentation. No cutaneous lesions were observed. The patient had mild neck stiffness and no abdominal skin reflexes; paraplegia was still noted, and there was decreased sensitivity below the T-8 level. A bladder catheter yielded 1.5 L of urine.A complete blood cell count revealed only macrocytosis and mild thrombocytopenia. A blood chemistry screening panel revealed mild azotemia and rhabdomyolysis. The level of glucose in CSF was 3.7 mmol/L, and the level of protein in CSF was 684 mg/dL. The white blood cell count in CSF was 32/mm 3 (50% lymphocytes, 32% reticulohistiocytes, 10% neutrophils, and 8% plasmocytes), and there were no red blood cells. Findings of a gram stain of CSF and the results of a cryptococcal antigen test were negative. Cultures of blood and urine were negative for bacteria, mycobacteria, and viruses, and culture of urine yielded cytomegalovirus (CMV). CSF samples were inoculated on hu-

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A Case of Herpes Zoster Myelitis: Positive Magnetic Resonance Imaging Finding

Cited by 19 publications

References 10 publications

Acute infectious disorders of the spinal cord and its roots with gadolinium-DTPA enhancement in magnetic resonance imaging

Acute infectious disorders of the spinal cord and its roots with gadolinium-DTPA enhancement in magnetic resonance imaging

Transverse myelitis caused by varicella zoster: case reports

Myelitis Due to Varicella-Zoster Virus in an Immunocompromised Patient Without a Cutaneous Rash

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