Atypical Manifestation of VZV Infection in a Vaccinated Immunocompetent Adult

Abstract

Introduction. Aseptic meningitis can occur from different types of infections of which viral etiologies are the most common. Varicella zoster virus (VZV) nowadays is considered a familiar entity of aseptic meningitis. However, it is usually reported in immunocompromised patients. For cases of VZV meningitis that are observed, a rash has been noted before the onset of meningitis or sometimes after it. Clinical Case. We present an uncommon case of VZV meningitis in an 18-year-old immunocompetent male who did not have a rash on presentation and did not develop one during his course either. Cerebrospinal fluid showed lymphocyte-predominant leukocytosis and elevated protein with normal glucose suggestive of aseptic meningitis. Cerebrospinal fluid polymerase chain reaction (CSF PCR) was positive for VZV; cerebrospinal fluid cultures and blood cultures were negative. The patient had complete resolution of symptoms with no complications on intravenous acyclovir therapy and was discharged home on oral valacyclovir therapy. Conclusion. It is important to consider varicella zoster virus as an etiology of aseptic meningitis as clinical presentation can be without a vesicular rash and in immunocompetent patients.

Varicella‐zoster virus‐related neurological complications: From infection to immunomodulatory therapies

“…144 VZV infection may cause an inflammatory response, which can weaken the BBB and allow immune cells and inflammatory mediators to enter the brain and spinal cord. 145,146 Aseptic meningitis associated with VZV infection typically presents with symptoms such as headache, fever, neck stiffness, photophobia, and neurological deficits. These symptoms result from the inflammatory processes and the resulting irritation of the meninges and surrounding nervous tissue.…”

“…VZV causes the meninges to become more amplified in the inflammatory cascade by eliciting an immunological response that is marked by the production of pro‐inflammatory cytokines such as IL‐6, TNF‐α, and IFN‐γ 144 . VZV infection may cause an inflammatory response, which can weaken the BBB and allow immune cells and inflammatory mediators to enter the brain and spinal cord 145,146 . Aseptic meningitis associated with VZV infection typically presents with symptoms such as headache, fever, neck stiffness, photophobia, and neurological deficits.…”