A case report of varicella-zoster virus-related cerebral infarction in an AIDS patient

Acquired immune deficiency syndrome (AIDS) patients with varicella-zoster virus (VZV) encephalitis rarely progress to cerebral infarction. This case highlights the potential for such complications in immunocompromised individuals.

A 33-year-old male with AIDS experienced recurrent hospitalizations due to neurological complications associated with VZV.

During the course of 3 hospitalizations, the patient's primary diagnoses included non-herpetic herpetic neuralgia, VZV meningoencephalitis, and cerebral infarction.

The patient initially presented with herpetic neuralgia due to VZV infection. Treatment with anti-VZV acyclovir, analgesics, and anti-human immunodeficiency virus therapy improved the patient's condition, leading to discharge. However, 8 days later, the patient developed fever, slurred speech, nausea, and vomiting. Testing confirmed VZV-related meningoencephalitis with high VZV deoxyribonucleic acid levels in the cerebrospinal fluid. Treatment included ganciclovir, foscarnet, and dexamethasone. Later, the patient suffered an acute cerebral infarction, resulting in limb paralysis and aphasia. Treatment adjustments included additional medications for VZV, human immunodeficiency virus, inflammation, antiplatelet function, and plaque stabilization, leading to improvement.

During rehabilitation, the patient has shown improvement in right limb paralysis and aphasia, achieving grade 4 muscle strength in the affected limb and enhanced basic communication abilities. However, complete recovery has not yet occurred.

This case emphasizes the rare but significant risk of cerebral infarction in AIDS patients with VZV infection. It underscores the importance of early diagnosis, aggressive management, and continuous monitoring of neurological symptoms to mitigate long-term disability and reduce mortality in this vulnerable population.