Varicella-zoster virus encephalomyelitis with a prominent demyelinating component.
Sarah Berth1, Olimpia Carbunar2, Ning Sarah Yang2
1Departments of Pathology.
Summary
Varicella-zoster virus (VZV) can cause encephalomyelitis with demyelination, mimicking multiple sclerosis, especially in immunocompromised patients. This case highlights VZV
Area of Science:
- Neurovirology
- Neuropathology
Background:
- Varicella-zoster virus (VZV) central nervous system infections present with varied histopathology.
- Understanding VZV neuropathology is crucial, particularly in immunocompromised individuals.
Observation:
- A patient with follicular lymphoma and allogeneic stem cell transplant developed VZV encephalomyelitis.
- Clinical presentation included fluctuating limb weakness and altered mental status.
- MRI revealed multifocal CNS lesions; VZV DNA was detected in cerebrospinal fluid.
Findings:
- Autopsy demonstrated significant demyelination in the spinal cord and cerebrum, with relative axonal preservation.
- Histopathology showed inclusion bodies and positive VZV immunostaining, confirming VZV as the cause.
- The demyelinating pathology resembled that of multiple sclerosis.
Implications:
- This case illustrates a rare presentation of VZV encephalomyelitis with prominent demyelinating features.
- The findings expand the differential diagnosis for demyelinating CNS diseases, especially in transplant recipients.
- Highlights the importance of considering VZV in unexplained neurological deficits post-transplantation.
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