A case of meningitis due to varicella zoster virus reactivation in an immunocompetent child

Abstract

BackgroundThe development of neurological complications due to varicella zoster virus (VZV) reactivation is relatively uncommon, particularly in the case of immunocompetent patients. Only a few cases have been described in the literature, most of which involved adult or elderly patients.Clinical presentationTwo days after his pediatrician had diagnosed herpes zoster and prescribed oral acyclovir 400 mg three times a day, a 14-year-old boy was admitted to our hospital because of mild fever, severe headache, slowness, drowsiness and vomiting. A cerebrospinal fluid examination was performed and showed an increased protein concentration (95 mg/dL), normal glucose level (48 mg/dL; blood glucose level, 76 mg/dL) and lymphocytic pleocytosis (1,400 lymphocytes/μL), and VZV DNA was detected by means of polymerase chain reaction (1,250 copies/mL). The results of immunological screening for HIV, lymphocyte subpopulation counts, serum immunoglobulin and complement (C3 and C4) levels, vaccine responsiveness and lymphocytes stimulation tests were unremarkable. Acyclovir was administered intravenously at a dose of 10 mg/kg three times a day and continued for 10 days. The therapy was highly effective and the patient’s clinical condition rapidly improved: fever disappeared after two days, and all of the signs and symptoms of neurological involvement after four days. The skin lesions resolved in about one week, and no pain or dysesthesia was ever reported. Given the favourable evolution of the illness, the child was discharged without further therapy after the 10-day treatment. The findings of a magnetic resonance examination immediately after the discontinuation of the antiviral therapy were normal, and a control examination carried out about four weeks later did not find any sign or symptom of disease.ConclusionVZV reactivation can also lead to various neurological complications in immunocompetent children. Prompt therapy with acyclovir and the integrity of the immune system are important in conditioning outcome, but other currently unknown factors probably also play a role.

Varicella Zoster aseptic meningitis: Report of an atypical case in an immunocompetent patient treated with oral valacyclovir

“…A systematic study on this topic may direct a need for reclassifying it as no longer atypical. It is important to suspect and test for VZV if a patient presents with aseptic meningitis, because with the development and availability of new technologies, such as antibody and PCR testing [ 5 , 13 ], it is often relativity easy to confirm the diagnosis and give patients the appropriate treatment. Currently, the IDSA recommendation for VZV-associated meningitis is to give the patient IV acyclovir 10–15 mg/kg Q8H for 10–14 days [ 14 ].…”

Varicella Zoster Meningitis in an Immunocompetent Child

“…Past medical history was unre- or without rash. Zosteriform rashes had developed before any symptoms of meningitis in some patients, easily leading to the suspicion of VZV meningitis [5][6][7] . According to a recent retrospective study of 24 patients with meningitis and meningoencephalitis who showed typical zosteriform skin rashes, CSF tests and intra- Fig.…”

Zeroing in on zoster: A tale of many disorders produced by one virus

“…The long-term outcomes of both varicella and zoster vaccines are still unknown. VZV in varicella vaccine becomes latent and can reactivate to produce meningitis [81] and VZV vasculopathy [82]. While repeated exposure to VZV may decrease rates of reactivation, vaccination may increase the incidence of zoster that might be reduced by boosters early on [83].…”