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Bilateral Ptosis, Zosteriform Rash and Flaccid Bladder in a 10-Year-old boy
Sara Adducchio1, Irma Reyes1,2, Mahesh Chikkannaiah1,2
1Dayton Children's Hospital, Dayton, Ohio, USA.
Insights
Varicella reactivation can cause neurological issues, including autonomic nervous system dysfunction, even in vaccinated children. A painful rash may appear weeks after initial neurological symptoms manifest.
Area of Science:
- Neurology
- Infectious Diseases
- Pediatrics
Background:
- Varicella zoster virus (VZV) reactivation typically causes shingles in immunocompromised individuals.
- Neurological complications from VZV are rare in immunocompetent hosts, particularly in vaccinated children.
Observation:
- A 10-year-old, fully vaccinated boy presented with bilateral eyelid drooping, fatigue, and autonomic dysfunction (bladder/bowel paralysis).
- A painful, itchy vesicular rash consistent with varicella reactivation appeared two weeks after the onset of neurological symptoms.
Findings:
- This case highlights that VZV reactivation can manifest as a primary neurological syndrome affecting the autonomic nervous system.
- The characteristic rash may be delayed by several weeks, potentially complicating early diagnosis.
Implications:
- Clinicians should consider VZV reactivation in the differential diagnosis of unexplained neurological syndromes in vaccinated, immunocompetent children.
- Early recognition of neurological symptoms, even without a rash, is crucial for timely diagnosis and management of varicella reactivation.
Abstract:
We present a case report of a 10-year-old completely immunized boy presenting with a 2-week history of bilateral eyelid drooping, fatigue followed by bladder and bowel paralysis. This was followed by the appearance of a vesicular painful and itchy rash which directed further diagnosis and treatment as it was consistent with a varicella reactivation rash. This case is a very important addition to the current body of literature on varicella-related neurological complications. It outlines that varicella reactivation can present in completely vaccinated, immunocompetent young children as a neurological syndrome affecting the autonomic nervous system primarily and the rash can occur a few weeks later after presentation of the neurological symptoms.
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