Severe Guillain–Barré syndrome following primary infection with varicella zoster virus in an adult

Abstract

Varicella zoster virus (VZV) infection may trigger Guillain-Barré syndrome (GBS), but this is rare and almost always in the context of reactivation disease from latent VZV, 'shingles'. We report here a case of severe GBS following primary VZV infection in an adult. A 40-year-old man of Indian origin developed features of GBS including quadriplegia, bulbar paralysis, and bilateral facial nerve palsies 14 days after primary VZV infection contracted from a known case in a family member. Nerve conduction studies confirmed acute inflammatory demyelinating polyneuropathy. Anti-ganglioside antibodies were negative. The mechanism of Schwann cell attack following VZV infection is poorly understood but this case suggests that primary VZV infection may be a sufficient stimulus to drive antibody generation and precipitate severe clinical symptomatology. The morbidity associated with the complications of VZV infection in adulthood could be avoided if patients who are seronegative for VZV (frequently from the Asian subcontinent) are offered prophylaxis after an exposure in adulthood.

An uncommon association: Chicken pox and Guillain–Barre syndrome

“…In patients with AIDP, the cellular immune system is activated: however, the humoral immune systems play a role in the pathogenesis of other subtypes of GBS [4,5]. Our patient's electrophysiological findings favored the diagnosis of AIDP, and she did not show humoral immunodeficiency.…”

Guillain-Barré Syndrome Following a Malignant Varicella in Immunocompetent Adult

“…Malignant varicella in adults Immunocompetent is an emergency involving the functional prognosis and vital with a risk of mortality, mainly related to pneumonia Varicella in 30%, greater after 50 years and complications Neurological disorders [4]. The treatment is based, in addition to the measures of resuscitation and local care on Aciclovir at 10 mg/kg/ 08h for one Minimum of seven days [1,2,4]. The delay in management anticipates mortality and functional sequelae [3].…”

“…Varicella zoster virus (VZV) is a rare cause of GBS, mainly in the case of latent infection reactivation [1,2]; we report here a case of severe GBS following primary VZV infection in an immunocompetent adult.…”

Herpesvirus Infections of the Central Nervous System

“…Guillain-Barré syndrome is a rare complication of VZV infection, occurring predominantly after an episode of HZ, and less frequently after acute varicella. 62 The diagnosis of varicella can be confirmed by a vesicle swab which is tested for VZV DNA by PCR. Similarly, HZ can be diagnosed by a vesicle swab for VZV DNA.…”