Herpes zoster central nervous system complication: An increasing trend of acute limbic encephalitis

Varicella zoster virus (VZV) causes chickenpox as the primary infection and then becomes latent in the cranial and spinal ganglia. VZV can reactivate with aging, immunosuppression, stress, and other factors. In our series of 15 patients with herpes zoster (HZ) central nervous system complications (8 males and 7 females, ages 41-86 years), we identified several types of complications: acute encephalitis, vasculitis, meningitis, and cranial nerve palsies, with acute limbic encephalitis (ALE) (n = 5) being particularly noteworthy. The elderly patient treated initially showed skin rash around the eye, altered consciousness, and medial temporal lesions on MRI; four similar patients were then observed. Aside from a few case reports, there are no comprehensive reports of HZ ALE. The HZ rashes of our five HZ ALE patients were mostly in the trigeminal nerve area, with two cases of disseminated rashes. Five patients had positive cerebrospinal fluid VZV polymerase chain reaction results, and MRI revealed medial temporal lobe lesions. Compared to HZ peripheral nerve complications, more variable invasive routes were presumed, via the brain-stem, vasculopathy root, meningeal spread, and viremia. The incidence of HZ is increasing worldwide, and clinicians should be aware of HZ ALE that shows fever, HZ skin rash, and altered consciousness.