Varicella-Zoster meningitis with normal CSF cellularity: A rare case report

Area of Science:

• Neurology
• Infectious Diseases
• Virology

Background:

• Varicella-zoster virus (VZV) reactivation can cause meningitis, typically presenting with fever and headache.
• Cerebrospinal fluid (CSF) analysis is key for diagnosing meningitis, usually showing lymphocytic pleocytosis in viral cases.
• Normal CSF findings in viral meningitis are rare but possible, necessitating further investigation.

Observation:

• An 89-year-old female presented with meningitis symptoms but had normal initial CSF analysis.
• Despite normal CSF results, polymerase chain reaction (PCR) testing confirmed VZV as the causative agent.
• The patient received appropriate treatment for VZV meningitis.

Findings:

• This case highlights that normal CSF analysis does not exclude VZV meningitis.
• PCR testing proved essential for accurate diagnosis in this patient.
• Early diagnosis and treatment led to a full recovery.

Implications:

• Physicians should consider VZV meningitis even with normal CSF, especially in elderly patients.
• Repeat CSF analysis or PCR testing may be warranted if suspicion remains high.
• Timely PCR testing can prevent diagnostic delays and ensure effective treatment for VZV meningitis.