Varicella Zoster--Associated Neurologic Disease Without Skin Lesions

Mayo, Donald R.; Booss, John

doi:10.1001/archneur.1989.00520390079020

Cited by 90 publications

(34 citation statements)

References 17 publications

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“…In most cases, transverse myelitis caused by VZV is diagnosed based on detection of typical vesicular lesions in dermatomal distribution that are associated with signs and symptoms suggestive of transverse myelitis. However, transverse myelitis associated with herpes zoster have been described in the absence of typical skin lesions [8].…”

Section: Discussionmentioning

confidence: 99%

Transverse myelitis caused by varicella zoster: case reports

2007

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Transverse myelitis is a group of disorders characterized by focal inflammation of the spinal cord and results in loss of motor and sensory function below the level of injury. Occurrence of this condition during or following varicella infection is uncommon. This report describes two cases of transverse myelitis caused by varicella zoster. Key-Words: Varicella zoster, infection, transverse myelitis. Received Varicella zoster virus (VZV) infection causes a variety of neurologic complications, including post-herpetic neuralgia, polyradiculoneuritis, transverse myelitis, vasculopathy, aseptic menengitis, leukoencephalopathy, dorsal root or cranial nerve ganglionitis, ventriculitis, necrotising angiitis and meningoencephalitis [1,2]. Transverse myelitis has been rarely associated with VZV infection. Onset is acute and occurs shortly after typical cutaneous rash in a dermatomal distribution with the development of paraparesis, sensory loss and sphincter dysfunction [3]. No diagnostic test is completely accurate, since VZV can not usually be isolated from blood or cerebrospinal fluid (CSF) in VZV myelitis. Treatment involves high doses of both steroids and acyclovir. Recovery is usually spontaneous, though fatal cases have been reported [4].We describe two cases of transverse myelitis during and following VZV infection that were proven serologically and neurologically. Case 1A 48-year-old woman was presented to our clinic in April 2003 with the complaints of right leg weakness and urinary incontinence. Two months before, she had experienced a painful vesicular eruption on the lateral side of her left breast. Herpes zoster was diagnosed, and she was treated with a 10-day course of oral acyclovir (800 mg five times daily). In March 2003, she had been admitted to another hospital with paresthesia and weakness in both legs. Magnetic resonance imaging (MRI) of the spinal cord demonstrated lesions of high-signal intensity at C1-2 and T2-3 levels. The lesions appeared to be masses, therefore subtotal laminectomy was performed at T1-3. Histopathologic examination showed perivascular lymphocyte infiltration and reactive gliosis.On admission to our center in April, neurologic examination revealed normal levels of consciousness, cooperation, orientation and showed that all cranial nerves were intact. The patient exhibited 1/5 lower extremity weakness on the right and 3/5 on the left, diminished sensation to pain and light touch below the level of T5 dermatome, and marked loss of vibratory sensation and proprioception in both legs. Deep tendon reflexes were normal in the upper extremities, but decreased in the lower extremities. There was no nuchal rigidity.Laboratory findings for complete blood cell count, liver enzymes, BUN, creatinine, C-reactive protein, erythrocyte sedimentation rate and urinalysis were normal. Serological tests for hepatitis B and C, brucellosis, cytomegalovirus, herpes simplex virus, Epstein-Barr virus, PPD and human immunodeficiency virus were all negative. The serum was positive for anti-VZV antibodies....

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Section: Discussionmentioning

confidence: 99%

Transverse myelitis caused by varicella zoster: case reports

2007

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“…However, transverse myelitis associated with herpes zoster has been described in the absence of typical skin lesions. 7 The pathogenesis of neurological complications associated with VZV infection is unclear, allergic and vascular mechanisms have been suggested. 8 In idiopathic acute transverse myelitis, there is an intraparenchymal or perivascular cellular influx into the spinal cord, resulting in the breakdown of the blood-brain barrier and variable demyelination and neuronal injury.…”

Section: Discussionmentioning

confidence: 99%

Varicella-zoster virus transverse myelitis in an immunocompetent patient

Alungal

Abdulla

Koya³

et al. 2014

Int J Res Med Sci

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“…Meningitis findings may start before the eruption occurs, may be simultaneous with the eruption or may develop in days after the eruption starts (12). Rarely, aseptic meningitis occurs without eruption (13,14). No relation could be found between the area of eruption and development of aseptic meningitis (3).…”

Section: Discussionmentioning

confidence: 99%

Zona zoster enfeksiyonu sırasında gelişen aseptik menenjit

...

2012

Tpa

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Sum maryZona zoster is generally a benign disease in immunocompetent children. In immunocompromised children, there is a risk of dissemination. Zona zoster rarely causes some neurological complications such as myelitis, aseptic meningitis, encephalitis and ventriculitis in both immunocompetent and immunocompromised children. A 17-year-old girl who had bone marrow transplantation for thalasemia major was admitted to our hospital with fever, itchy rash on the right chest and axillary region and diagnosed as zona zoster. She had severe headache and vomiting on follow-up. Lumbar puncture was performed, because of positive neck stiffness and meningeal irritation signs and pleocytosis and protein elevation were detected in the cerebrospinal fluid (CSF). The diagnosis of aseptic meningitis due to zona zoster was confirmed by VZV-PCR in the CSF . She cured without sequelea after the administration of acyclovir treatment for 10 days. If symptoms such as headache and vomiting develop in immunocompromised children with zona zoster, neurological complications including aseptic meningitis should be remembered. (Turk Arch Ped 2012; 47: 142-5)

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Varicella Zoster--Associated Neurologic Disease Without Skin Lesions

Cited by 90 publications

References 17 publications

Transverse myelitis caused by varicella zoster: case reports

Transverse myelitis caused by varicella zoster: case reports

Varicella-zoster virus transverse myelitis in an immunocompetent patient

Zona zoster enfeksiyonu sırasında gelişen aseptik menenjit

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