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VZV myelitis with secondary HIV CSF escape
Julian J Weiss1,2, Serena Spudich1, Lydia Barakat3
1Neurology, Yale University School of Medicine, New Haven, Connecticut, USA.
BMJ Case Reports
|June 30, 2021
Summary
Varicella zoster virus (VZV) reactivation caused myelitis in an HIV-positive patient with treatment non-adherence. This rare complication highlights the need to consider VZV CNS infections and secondary HIV CSF escape in immunocompromised individuals.
Area of Science:
- Neurology
- Infectious Diseases
- Immunology
Background:
- Antiretroviral therapy (ART) adherence is crucial for managing Human Immunodeficiency Virus (HIV).
- Non-adherence can lead to viral rebound and opportunistic infections.
Observation:
- A 52-year-old woman with HIV and recent ART non-adherence presented with painful vesicular skin lesions.
- Direct fluorescent antibody testing confirmed Varicella Zoster Virus (VZV) in skin lesions.
- She developed acute right upper extremity weakness, with MRI suggesting VZV myelitis.
Findings:
- Cerebrospinal fluid (CSF) analysis revealed VZV PCR positivity and detectable HIV viral load, indicating secondary HIV CSF escape.
- Treatment included intravenous acyclovir, oral famciclovir/valacyclovir, and dexamethasone.
- The patient achieved near-full recovery within 6 months.
Implications:
- Reactivated VZV infection can cause rare myelitis complications, particularly in immunocompromised patients.
- Secondary HIV CSF escape should be considered in immunosuppressed individuals with concurrent central nervous system infections.
- Prompt diagnosis and treatment are essential for favorable outcomes in VZV-related neurological complications.
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