Headaches after renal transplantation--a case report

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Headaches are common, but differentiating benign from serious secondary causes is critical.
• Renal transplant recipients have compromised immunity, increasing risks for opportunistic infections like Varicella zoster virus (VZV).
• VZV reactivation can lead to severe complications, including meningitis, especially in immunocompromised individuals.

Observation:

• A 49-year-old renal transplant patient presented with intractable, unilateral headaches.
• Initial cerebral imaging was unremarkable, delaying diagnosis.
• A dermatomal rash of grouped vesicles appeared two days later, followed by positive cerebrospinal fluid for VZV.

Findings:

• The patient was diagnosed with VZV meningitis, an atypical presentation of VZV reactivation.
• Cerebrospinal fluid analysis confirmed the presence of Varicella zoster virus.
• Intravenous acyclovir therapy led to rapid clinical improvement.

Implications:

• This case highlights the importance of considering VZV meningitis in transplant patients with unexplained headaches, even without a rash.
• Prompt diagnosis and antiviral therapy are essential to prevent severe VZV complications in immunocompromised hosts.
• Pre-transplant Varicella zoster virus vaccination for seronegative patients is recommended to reduce reactivation risks.