Varicella Zoster Virus Cerebellitis Without a Rash in an Immunocompetent 85-Year-Old Patient
Smadar Shilo1, Yonit Wiener-Well, Isabelle Korn-Lubetzki
1Departments of *Internal Medicine †Infectious Disease Unit ‡Neurology, Shaare Zedek Medical Center, Jerusalem, Israel.
The Neurologist
|September 17, 2015
Summary
Varicella zoster virus (VZV) cerebellitis can occur without a rash in adults. Neurological symptoms like tremor and ataxia may indicate VZV cerebellitis, even with normal imaging.
Area of Science:
- Neurology
- Virology
- Infectious Diseases
Background:
- Varicella zoster virus (VZV) reactivation in adults typically presents with a rash.
- Neurological VZV reactivation without a rash is rare, with few reported cases of VZV cerebellitis.
- Previous literature documented only three cases of VZV cerebellitis without rash, confirmed by cerebrospinal fluid analysis.
Observation:
- An 85-year-old immunocompetent male presented with new-onset tremor.
- The patient exhibited no cutaneous rash.
- Brain imaging (CT and MRI) and initial cerebrospinal fluid analysis showed normal or minimal findings.
Findings:
- The patient was diagnosed with VZV cerebellitis based on virological examination.
- This case highlights a rare presentation of VZV cerebellitis.
- Diagnosis was confirmed despite the absence of typical clinical and radiological signs.
Implications:
- New-onset tremor and gait ataxia in adults should prompt consideration of VZV cerebellitis.
- The diagnosis of VZV cerebellitis should be considered even without a rash or characteristic imaging findings.
- This case expands the understanding of VZV neurological manifestations.
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