Extensive VZV Encephalomyelitis without Rash in an Elderly Man.
Karen Lynch1, Prakhar Agarwal2, Anu Paranandi3
1Department of Neurology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
Case Reports in Neurological Medicine
|May 28, 2014
Summary
Varicella zoster virus (VZV) encephalomyelitis can occur without a rash, even in immunocompetent individuals. Early diagnosis and antiviral treatment are crucial for reducing severe outcomes in VZV CNS infections.
Area of Science:
- Neurology
- Infectious Diseases
- Virology
Background:
- Varicella zoster virus (VZV) encephalomyelitis is a rare neurological condition.
- It typically presents with a rash and affects immunocompromised individuals.
- However, VZV neurological disease can manifest without a rash.
Purpose of the Study:
- To report a rare case of VZV encephalomyelitis in an elderly, immunocompetent patient presenting without a rash.
- To emphasize the importance of considering VZV CNS infection even in the absence of characteristic symptoms.
- To highlight the necessity of prompt diagnosis and sustained antiviral therapy.
Main Methods:
- Case report of a 78-year-old male with progressive neurological deficits.
- Diagnostic workup included MRI of the neuraxis and cerebrospinal fluid (CSF) analysis.
- CSF analysis involved cell count, protein levels, VZV PCR, and VZV IgM antibody detection.
Main Results:
- The patient presented with paraparesis, sensory loss, malaise, and fevers.
- MRI revealed extensive VZV-related lesions in the brain and spinal cord.
- CSF confirmed VZV infection with pleocytosis, elevated protein, positive VZV PCR, and IgM antibodies.
- Intravenous acyclovir treatment led to clinical and radiological improvement.
Conclusions:
- This case highlights VZV encephalomyelitis in an immunocompetent host without a rash.
- The study underscores the importance of considering VZV CNS infection irrespective of rash presence.
- Timely recognition and treatment of VZV encephalomyelitis are vital for improving patient outcomes and preventing mortality.
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