Disseminated herpes zoster with acute encephalitis in an immunocompetent elderly man

Oh, Jessica Hyejin; Tummala, Saketh; Husnain, Muhammad

doi:10.1136/bcr-2019-232928

Cited by 6 publications

(3 citation statements)

References 45 publications

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“…However, pathogens of encephalitis in older adults may be different from those in children, and various pathogens are possible. [48][49][50] Therefore, rapid molecular diagnostic technologies and early antiviral treatment are particularly important for older adults. The incidence of autoimmune encephalitis is also higher in this population, [51][52][53] and appropriate acute immunotherapy, bridging therapy, maintenance of immunosuppression, and symptomatic treatment are essential for the success of treatment.…”

Section: Discussionmentioning

confidence: 99%

Global magnitude of encephalitis burden and its evolving pattern over the past 30 years

Wang

Zhao

Wang

et al. 2022

Journal of Infection

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Section: Discussionmentioning

confidence: 99%

Global magnitude of encephalitis burden and its evolving pattern over the past 30 years

Wang

Zhao

Wang

et al. 2022

Journal of Infection

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“…To date, a total of 22 immunocompetent patients have been reported to develop disseminated zoster. 3 , 4 , 6 , 9 - 27 Most of the patients with disseminated zoster complained of headache, skin vesicle, dizziness, and pain in the face, trunk, and upper extremity as initial symptoms ( Table 1 ). However, no patients complained of leg pain and weakness as initial symptoms, as in the patient in our case.…”

Section: Discussionmentioning

confidence: 99%

Disseminated Zoster Involving the Whole Body in an Immunocompetent Patient Complaining of Left Leg Radiating Pain and Weakness: A Case Report and Literature Review

Moon

Cho

Jung

et al. 2022

Geriatr Orthop Surg Rehabil

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Introduction Disseminated herpes zoster is defined as at least 20 skin lesions in multiple dermatomes. In particular, it has been reported mainly in patients with immunological defects. To our knowledge, there is no reported case of disseminated zoster in a non-immunocompromised patient with leg radiating pain and weakness. Case presentation A 74-year-old man visited our hospital with left leg radiating pain and left hip pain. He had no underlying disease other than hypertension. Neurologic examination revealed radiating pain on the L4 dermatome of the left leg. The muscle power was grade 3 for the hip flexor and knee extensor, and grade 4 for the ankle dorsiflexor and big toe dorsiflexor of the left leg. There were no sensory changes or skin lesions on his left leg. Herniation of the nucleus pulposus of the lumbar spine was suspected and lumbar magnetic resonance imaging (MRI) was performed. However, no pathologic lesions were seen on lumbar MRI. On the third day of hospitalization, erythematous patches and vesicles were observed on the head, face, ear, neck, trunk, back, and both lower extremities. Herpes zoster infection was confirmed by polymerase chain reaction analysis. Treatment was performed with 250 mg of intravenous acyclovir every 8 hours for 6 days and 62.5 mg of intravenous methylprednisolone for 4 days. On the 13th day of hospitalization, the skin lesions and left leg radiating pain and weakness improved. Conclusion We report the first case of disseminated herpes zoster involving the whole body in a non-immunocompromised patient complaining of left leg radiating pain and weakness. After treatment, both the patient’s radiating pain and weakness improved.

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“…Notably, VZV encephalitis can follow or proceed the appearance of rash by approximately 1 week in a patient with DCHZ, forty percent of whom will have asymptomatic CNS infection and have a higher risk of ischemic attacks, making it crucial to institute early treatment to prevent its fatal complications. From these cases, all of the reported patients were above the age of 75 years or being immunocompromised status, including human immunodeficiency virus or post-transplant patients [ 17 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Varicella-Zoster Virus Encephalitis in an Immunocompetent Adult with Disseminated Cutaneous Herpes Zoster after Testosterone Booster Supplements: Case Report

Alhayaza¹,

Al-Omair²,

Almohanna³

2022

Case Rep Dermatol

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Disseminated zoster affects immunocompromised individuals and has a nondermatomal distribution. We report a 28-year-old male who initially presented to the dermatology clinic with pinprick sensation over the right side of his face that was followed by vesicular eruption. Upon which he was diagnosed with herpes zoster and discharged on topical mupirocin ointment three times a day for 7 days and valacyclovir 1 g oral three times a day. A few hours later, he presented to the emergency department with drowsiness and an episode of loss of consciousness. He was then admitted by neurology and found to have herpetic encephalitis. During admission, he was started on intravenous acyclovir 10 mg/kg three times a day. After 3 weeks of intravenous acyclovir, the patient improved clinically; and all the vesicular lesions have crusted. Up to this date, there are only a few cases of immunocompetent adult patients with disseminated cutaneous herpes zoster (DCHZ), most of whom were over the age of 65 years or taking immunosuppressive medication. We report a case of DCHZ and varicella-zoster virus encephalitis in a young immunocompetent patient using daily testosterone supplements and a history of emotional and physical stress, in contrast to all previously reported cases, which presented significant risk.

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Disseminated herpes zoster with acute encephalitis in an immunocompetent elderly man

Cited by 6 publications

References 45 publications

Global magnitude of encephalitis burden and its evolving pattern over the past 30 years

Global magnitude of encephalitis burden and its evolving pattern over the past 30 years

Disseminated Zoster Involving the Whole Body in an Immunocompetent Patient Complaining of Left Leg Radiating Pain and Weakness: A Case Report and Literature Review

Varicella-Zoster Virus Encephalitis in an Immunocompetent Adult with Disseminated Cutaneous Herpes Zoster after Testosterone Booster Supplements: Case Report

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