Varicella zoster virus meningo-encephalo-myelitis in an immunocompetent patient

Abstract

Objective-To describe clinical, MRI and cerebrospinal fluid (CSF) features of a varicella zoster virus (VZV) related meningo-encephalo-myelitis (MEM) without rash in an immunocompetent female. Conclusion-We highlight the importance of considering the possibility of VZV related MEM, even in immunocompetent patients. We also provide a MRI description of VZV related multifocal myelitis, not previously available. As supported by other reports, we underline the necessity of a prompt therapeutic intervention in this life-threatening condition Patient-An

Recombinant Canine Distemper Virus Strain Snyder Hill Expressing Green or Red Fluorescent Proteins Causes Meningoencephalitis in the Ferret

“…While this may facilitate migration of leukocytes into the subarachnoid space during routine immune surveillance, pial microvessels might also be more amenable than cerebral microvessels to the migration of rCDV SH -infected leukocytes. Viral meningitis can occur as a serious complication of a number of common childhood infections, including varicella-zoster virus, enterovirus, and mumps virus (31,36,43), and in rare cases has also been a complication associated with measles (27,32). The pathological consequences of extensive viral replication in meningeal cell layers have recently been demonstrated in lymphocytic choriomeningitis virus-infected mice (24).…”

Recurrent polymorphonuclear pleocytosis with increased red blood cells caused by varicella zoster virus infection of the central nervous system

“…In contrast, in a patient with recurrent VZV myelopathy, anti-VZV IgG antibody in CSF was detected only during acute episodes, but not during symptom free intervals [5]. VZV is well documented to cause myelitis, including recurrent myelopathy [5,6], along with coexisting meningoencephalitis and multifocal vasculopathy [7-9]. Furthermore, given that all neurological complications of VZV reactivation can occur without rash [1], and that about 37% cases of VZV vasculopathy develop without rash [4], including CNS disease in immunocompetent patients [3,10-14], it is not surprising that none of our patient's episodes of neurological disease was associated with zoster rash.…”

Varicella-zoster virus infections of the central nervous system – Prognosis, diagnostics and treatment

“…The pleocytosis ranges from only a few WBC up to several thousands [44,4], and tends to be less pronounced in children [20]. An elevated CSF/-serum albumin ratio, indicating blood-brain barrier damage, is a frequent finding in VZV vasculopathy [75] and is also reported in encephalitis, myelitis and facial palsies caused by VZV [102,103].…”