Herpes zoster myelitis: nervous system complications

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Transverse myelitis is an inflammation of the spinal cord.
• Zoster viral infections, caused by the varicella-zoster virus (V-Z), are typically associated with dermatomal rashes.
• Neurologic complications from V-Z infections are uncommon.

Observation:

• A patient presented with transverse myelitis following a zoster viral infection.
• Antibody activity against varicella-zoster virus (V-Z) was detected in the cerebrospinal fluid.
• Coxsackie A enterovirus was also identified in association with the V-Z antibodies.
• The patient experienced a second episode of myelitis two years after the initial neurologic event, an atypical clinical course.

Findings:

• The presence of V-Z antibodies in cerebrospinal fluid alongside Coxsackie A enterovirus suggests a complex viral interaction.
• The recurrent nature of myelitis in this patient is unusual for V-Z associated complications.
• Therapeutic intervention with Acyclovir resulted in a positive clinical outcome.

Implications:

• This case expands the understanding of rare neurologic complications following zoster viral infections.
• The findings suggest a potential role for specific antibody responses and co-infections in the pathogenesis of transverse myelitis.
• The efficacy of Acyclovir in this context warrants further investigation for V-Z related myelitis.