Brain stem encephalitis due to varicella-zoster virus in a patient with AIDS

We describe a patient infected with human immunodeficiency virus (HIV) who had localized brain stem encephalitis due to varicella-zoster virus (VZV) and no cutaneous eruption. Diagnosis of the infection was based on the presence of Cowdry type A intranuclear inclusions in neurons, astrocytes, and oligodendrocytes positive for VZV (as shown by immunochemical staining). Although this infection is rare, we demonstrate the need for clinicians to include VZV infection in the differential diagnosis of rapidly progressive multiple cranial nerve palsies in HIV-infected patients, particularly because specific treatment for VZV infection is effective and relatively safe.