Neurological Complications Associated With Varicella-Zoster Virus Infection

Varicella-zoster virus is a highly contagious infection that primarily affects children. It typically presents as a mild, self-limiting illness with a distinctive rash. However, severe complications can arise, with skin and soft tissue infections being the most common. While neurological complications are less frequent, they are particularly serious and may include conditions such as encephalitis, meningitis, and transient neurological deficits. We report a case of a six-year-old child with neurological complications related to varicella. Initially, the child presented with the typical rash, fever, headache, and nausea. He was discharged after unremarkable physical and bloodwork analysis. Thirty-six hours later, his condition deteriorated: worsened headaches, ataxic gait, central hypotonia, and dysarthric speech. His bloodwork and computed tomography scan were normal, but cerebrospinal fluid (CSF) analysis showed pleocytosis and elevated protein levels; viral polymerase chain reaction and autoantibody tests in CSF were negative. His diagnosis was autoimmune encephalitis related to an infectious process, and he was treated with acyclovir and methylprednisolone for several days before any improvement. At one-month follow-up, minor neurological deficits persisted, but substantial improvement was achieved with physiotherapy and speech therapy. Although varicella is typically mild, it can lead to severe complications. This case illustrates the diagnostic and therapeutic challenges associated with neurologically complicated varicella infections. It also highlights the importance of comprehensive evaluation and management, as well as the long period that may be required for improvement. The response to acyclovir was lacking, and the CSF was negative, suggesting an immune-mediated process, emphasizing the complexity of postinfectious encephalitis. This case highlights the need for vigilance in pediatric varicella infections, particularly concerning neurological complications. A thorough clinical assessment and laboratory work-up are crucial to better diagnosing and properly addressing these complications. Early intervention and comprehensive rehabilitation are key to improving outcomes in children affected by such complications.