Headaches after renal transplantation--a case report

Headaches are one of the most common medical complaints. The differentiation of benign primary headaches from the small number of patients with secondary headaches may be challenging, but failure to recognize a serious headache can be fatal. We report the case of a 49-year-old renal transplant patient, who was admitted to hospital because of intractable right-sided headaches. Cerebral imaging was unremarkable. Not until 2 days later did the patient develop a rash of grouped vesicles located in the right dermatome C3. Consecutively cerebrospinal fluid tested positive for Varizella zoster virus (VZV), indicating VZV meningitis. Therapy was started with intravenous acyclovir with rapid improvement. Here in we have described an atypical case of VZV reactivation in a renal transplant patient, who initially presented with headaches without any skin manifestation. Because of their compromised immune system, transplant patients have a high risk for visceral involvement of VZV infections, which are a life-threatening emergency. Therefore, vaccination of seronegative patients should be part of the pretransplant workup. Accurate and fast diagnosis of infection is essential to immediately start antiviral therapy.