[On the wrong track: Misled by the patient history]

Area of Science:

• Neurology
• Infectious Diseases
• Virology

Background:

• Aseptic meningitis is an uncommon presentation of varicella-zoster virus (VZV) reactivation.
• VZV meningitis can occur in immunocompetent individuals.
• Vesicular rash may be absent in VZV meningitis cases.

Purpose of the Study:

• To report a case of aseptic meningitis caused by VZV in a young, immunocompetent patient.
• To highlight the diagnostic considerations for VZV meningitis, especially when rash is absent.
• To emphasize the importance of early antiviral intervention for VZV-related neurological complications.

Main Methods:

• Case report detailing clinical presentation, diagnostic workup, and treatment.
• Review of relevant literature on VZV infections and aseptic meningitis.

Main Results:

• The patient, a young immunocompetent individual, presented with aseptic meningitis.
• Diagnosis confirmed as VZV infection, despite the absence of a typical vesicular rash.
• Favorable clinical outcome achieved following prompt initiation of antiviral therapy.

Conclusions:

• Varicella-zoster virus should be considered in the differential diagnosis of aseptic meningitis, particularly in young, immunocompetent patients.
• The absence of a rash does not exclude VZV as the causative agent.
• Timely antiviral treatment is crucial for managing VZV meningitis and ensuring a positive prognosis.