Challenges in Diagnosing Varicella-Zoster Virus Encephalitis in an Immunocompromised Patient

Varicella-zoster virus (VZV) is a virus of the alphaherpesvirus family that is one of the common causes of infectious encephalitis worldwide, especially among those who are immunocompromised. In this case report, we discuss a case of a 55-year-old female with end-stage renal disease presenting with altered mental status and weakness. She was recently diagnosed with herpes zoster on oral acyclovir and multiple scattered dermatomal rashes on presentation. Cerebral spinal fluid analysis showed neutrophilic pleocytosis, high glucose and protein, and anti-VZV Immunoglobulin G (IgG) antibodies. She was started on treatment early with acyclovir and demonstrated good clinical improvement afterward two weeks. This case highlights to importance of performing lumbar puncture and looking for anti-VZV antibodies to rule out encephalitis in patients with altered mental status and starting acyclovir treatment early.