A Case of Aseptic Meningitis Without Rash Possibly Associated With Varicella Vaccine

Area of Science:

• Pediatric Neurology
• Infectious Diseases
• Virology

Background:

• Varicella-zoster virus (VZV) is a common cause of childhood illness, typically presenting with a rash.
• Aseptic meningitis is an inflammation of the meninges not caused by typical bacterial infections.
• The VZV vaccine (Oka/Biken strain) is widely used in pediatric populations.

Observation:

• A 13-year-old boy presented with symptoms of aseptic meningitis, including headache, vomiting, and fever.
• The patient had received one dose of the VZV vaccine at one year of age and had no history of VZV exposure.
• Crucially, the child did not develop a skin rash during the illness.

Findings:

• Cerebrospinal fluid (CSF) analysis revealed a high white blood cell count with a predominance of mononuclear cells.
• Symptoms resolved spontaneously after a lumbar puncture, and the patient was discharged without specific antiviral treatment.
• A significant rise in serum VZV-IgG antibodies was detected two weeks post-admission, confirming VZV infection.

Implications:

• VZV infection should be considered in the differential diagnosis of pediatric aseptic meningitis, even in vaccinated individuals.
• The absence of a characteristic skin rash does not rule out VZV as a cause of meningitis.
• Consider VZV DNA testing via PCR in CSF for suspected cases, especially when a rash is absent.