A Case of Transverse Myelitis Caused by Varicella Zoster Virus in an Immunocompetent Older Patient

Abstract

Varicella zoster virus (VZV) is a human neurotropic alphaherpesvirus that causes chickenpox (varicella) in children. VZV reactivation may lead to neurological complications, including transverse myelitis. However, transverse myelitis caused by VZV reactivation is rare in immunocompetent patients. Herein, we report a case of transverse myelitis caused by VZV in an immunocompetent older patient, and confirmed this case by polymerase chain reaction. A 79-year-old woman visited our service with complaints of weakness in the right lower leg, generalized vesicular eruptions, and throbbing pain in the right flank for ten days. Spine MRI showed transverse myelitis in the thoracic spine at level T4–T11. The patient was treated with acyclovir and her neurological functions improved, except for sensory impairment below level T10. For older patients, early and aggressive antiviral treatment against VZV may be necessary even though these patients are immunocompetent.

Tuberculous Meningitis-Mimicking Varicella-Zoster Meningitis

“…Varicella-zoster virus (VZV) is an α-herpesvirus with the ability to establish latency in dorsal-root ganglia or cranial-nerve ganglia. Central nervous system (CNS) manifestations can follow both primary infection or reactivation by VZV and occur without concomitant skin rash in up to a third to half of patients, referred to as "zoster sine herpete" [ 1 2 ]. The spectrum of CNS diseases caused by this virus is broad, ranging from self-limiting aseptic meningitis to encephalitis, causing death and disability.…”

Myelitis due to Varicella-Zoster Infection in an Adult Immunocompetent Patient at Yalgado Ouedraogo University Teaching Hospital (Burkina Faso)

“…Several cases of VZV myelitis in adult patients have been described in the literature [11,[14][15][16][17][18][19][20][21]. Some of these cases concerned immunocompetent patients aged 20 to 79 years [14][15][16][17][18][19]. In our case, our patient had no defect, the biological balance was normal (blood sugar, hepatic, HIV serology, CD4).…”

“…This study reports a case of acute transverse myelitis caused by VZV infection in an adult immunocompetent patient. Several cases of VZV myelitis in adult patients have been described in the literature [11,[14][15][16][17][18][19][20][21]. Some of these cases concerned immunocompetent patients aged 20 to 79 years [14][15][16][17][18][19].…”

“…Corticosteroid therapy was combined as a 120 mg/day bolus for 3 days followed by oral corticosteroid therapy. In some studies, patients were treated with only intravenous acyclovir for 21 days without steroids [17,19]. However, the use of acyclovir was not consistent in all series.…”

Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual—A Rare Complication of Varicella-Zoster Virus Reactivation

“…Apart from this common presentation, reactivation of VZV can result in severe neurologic manifestations such as encephalitis, meningitis, and myelitis [1]. In the latter context, longitudinal extensive transverse myelitis (LETM) is an unusual severe neurological complication that has been mainly described in immunocompromised patients [1], with very few cases reported in immunocompetent ones [2,3,4]. Moreover, in a few cases, VZV-induced LETM was associated with anti-aquaporin-4 antibody serology suggesting a potential conversion to neuromyelitis optica spectrum (NMOS) disorder [5,6,7,8].…”