Varicella-Zoster Virus Meningitis and Encephalitis: An Understated Cause of Central Nervous System Infections

Álvarez, José Carlos Pena; Álvarez, Jorge Blanco; Tinoco, Javier; Mellado, Patricio; Miranda, Héctor; Ferrés, Marcela; Forero, Jonathan; Álvarez, Cristiam M.

doi:10.7759/cureus.11583

Cited by 20 publications

(19 citation statements)

References 18 publications

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“…Here we report an atypical case of a 31-year-old immunocompetent patient with mild diabetes but no cutaneous lesions developed meningitis, encephalitis, and myelitis as a result of VZV reactivation. In the previous literature, CNS complications due to VZV infection usually manifesting as meningitis or encephalitis [5] . It was initially thought of as a mild disease that VZV is not routinely tested in CNS infections, although acute VZV CNS infections have been suggested to contribute to subsequent neurological impairment globally [6,7] .…”

Section: Discussionmentioning

confidence: 99%

Atypical varicella-zoster virus meningitis in a young immunocompetent adult during enterovirus epidemic season: A case report and literature review

Liu,

Shi,

Dai

et al. 2024

Preprint

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Background Varicella-zoster virus (VZV) can cause acute brain infection manifesting as meningitis or encephalitis, which more likely occurs in winter and population with immunocompromised conditions[1]. During the enterovirus epidemic season, VZV meningitis is easy to be ignored and misdiagnosed, especially when the typical dermatomal rash is absent. Case presentation Here, we present an atypical case of a young immunocompetent male with VZV meningitis and encephalitis during summer. The patient presented with fever, headache and vomiting, but without dermatomal rash. Metagenomic Next-generation Sequencing (mNGS) of cerebrospinal fluid (CSF) revealed VZV infection. He was treated successfully with acyclovir and recovered without any neurological sign. Conclusions This case report describes a patient with mild diabetes but no immunocompromised condition who developed meningitis and encephalitis resulting from VZV infection in summer. Additionally, there is no dermatomal rash in the patient. It can broaden the understanding of the disease, and keep VZV infection in differential diagnoses of viral meningitis.

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Section: Discussionmentioning

confidence: 99%

Atypical varicella-zoster virus meningitis in a young immunocompetent adult during enterovirus epidemic season: A case report and literature review

Liu,

Shi,

Dai

et al. 2024

Preprint

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“…VZV also can affect multiple organs including the central nervous system (CNS), which presents a spectrum of conditions, such as meningitis, encephalitis, and vasculopathy, which can present as primary or reactivation infections with possible neurological sequelae [ 14 ]. In patients with suspected meningitis or encephalitis and other CNS complications due to VZV, the diagnosis should be on clinical suspicion, with confirmation that can be done using viral DNA demonstrable in cerebrospinal fluid [ 15 ].…”

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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“…Earlier, VZV was not as routinely tested on CSF as enterovirus and HSV 1, 2. However, given better diagnostic studies and wide availability of multiplex PCR testing, the incidence of VZV meningitis has been rising [4]. Primary varicella infections as well as reactivated infections can lead to CNS manifestations in immunocompromised patients and uncommonly in immunocompetent patients.…”

Section: Discussionmentioning

confidence: 99%

“…A reduction in neurological morbidity has been observed with antiviral therapy due to which it is essential to diagnose VZV meningitis promptly [4]. Several antiviral agents are efective against VZV; however, acyclovir is the drug of choice given its higher efcacy with lower adverse events.…”

Section: Discussionmentioning

confidence: 99%

Atypical Manifestation of VZV Infection in a Vaccinated Immunocompetent Adult

Bhojwani

Zakarya

Khalaf

2022

Case Reports in Infectious Diseases

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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.

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Varicella-Zoster Virus Meningitis and Encephalitis: An Understated Cause of Central Nervous System Infections

Cited by 20 publications

References 18 publications

Atypical varicella-zoster virus meningitis in a young immunocompetent adult during enterovirus epidemic season: A case report and literature review

Atypical varicella-zoster virus meningitis in a young immunocompetent adult during enterovirus epidemic season: 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

Atypical Manifestation of VZV Infection in a Vaccinated Immunocompetent Adult

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