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

Abstract

Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult—a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies.

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

“…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].…”

A Case Report of Acute Severe Myelitis and Meningitis Secondary to Varicella Zoster Virus Reactivation in a Patient with Acquired Immunodeficiency Syndrome

“…14,15 The reported cases of FRS, in the context of a CNS invasion by VZV, are mostly related to encephalitis, with only one case associated with myelitis, but none have been found to be associated with myelitis and meningitis simultaneously, which makes this case unique. 5,16,17 Standard treatment has not been established, and some authors have proposed the use of acyclovir combined with a corticosteroid regimen, while others opt for the single use of antivirals, with differences and inconsistencies in the outcomes. 8,9,14,15 This explains the need to carry out more specific studies that allow for establishing a treatment that improves the prognosis of these patients.…”

Myelitis and Radiculitis Complicating Varicella-Zoster Virus Reactivation

“…Diogo Goulart Corrêa [1], [2] , Niedja Santos Gonçalves Tsuno [3] and Luiz Celso Hygino da Cruz Júnior [1] [1]. Clínica de Diagnóstico por Imagem/DASA, Departamento de Radiologia, Rio de Janeiro, RJ, Brasil.…”

“…Universidade Federal Fluminense, Departamento de Radiologia, Niterói, RJ, Brasil. [3]. Laboratório Exame/DASA, Departamento de Radiologia, Brasília, DF, Brasil.…”

“…The pathogenesis of VZV-related myelitis is postulated to be related to direct viral invasion. Vascular and autoimmune mechanisms have also been proposed in its pathophysiology 3 .…”