RESUMEN
Varicella zoster virus (VZV) reactivation, also known as herpes zoster is common in older adults and immunocompromised individuals and often causes a painful, vesicular rash limited to a dermatomal distribution. On occasion, it can lead to various neurological complications as well. Here we present the case of a young, immunocompetent male in his 20's with a history of primary varicella infection who presented with complaints of a painful rash in the S3-S4 dermatomal distribution. Despite being initiated on the standard oral antiviral dose for two days, he developed a headache and neck stiffness. He was diagnosed with VZV meningitis through the lumbar puncture and cerebrospinal fluid polymerase chain reaction (PCR) assay analysis. The patient reported significant improvement in symptoms following intravenous acyclovir and was discharged with additional oral valacyclovir at a higher-than-standard dosage. Our case highlights that even in relatively low-risk patients, physicians must maintain a high level of clinical suspicion for the complications of VZV reactivation even after beginning the oral antiviral medication.
RESUMEN
Varicella-zoster (VZ) meningitis is uncommon in patients with immunocompetence and usually presents with typical rash and fever. However, VZ meningitis can rarely present with symptoms of intracranial hypertension without the classic manifestations. Herein, we describe a 17-year-old female teen who presented with intractable headache and vomiting and diagnosed with VZ meningitis. Her symptoms remarkably improved after a lumbar puncture and acyclovir therapy.
RESUMEN
Varicella zoster virus reactivation after COVID-19 vaccination has been reported in older or immunocompromised adults. We report zoster meningitis from live-attenuated varicella vaccine reactivation in an immunocompetent child after COVID-19 vaccination. This type of case is rare; COVID-19 and varicella vaccines remain safe and effective for appropriate recipients in the pediatric population.
Asunto(s)
COVID-19 , Varicela , Vacuna contra el Herpes Zóster , Herpes Zóster , Meningitis , Adulto , Anciano , Vacunas contra la COVID-19 , Niño , Herpes Zóster/prevención & control , Humanos , VacunaciónRESUMEN
Herpes zoster opthalmicus (HZO) is the reactivation of latent varicella zoster virus (VZV) within the ophthalmic branch of the trigeminal ganglion (V1). Common complications are postherpetic neuralgia and vasculopathy. Here, we report a rare case of a 47-year-old female presenting with HZO and aseptic cavernous sinus thrombosis (CST). Early screening for rare and deadly complications such as CST using CT cerebral venography (CTV) and magnetic resonance venography (MRV), as was done, is crucial to detection at earlier stages when intervention is most effective. Anticoagulation therapy was promptly started, and the patient's symptoms continued to improve during the hospital stay.
RESUMEN
Varicella zoster meningitis is an uncommon complication of herpes zoster, especially in immunocompetent patients. We report a case of a healthy 45-year-old male who developed aseptic meningitis as a result of reactivated varicella zoster virus infection. This case highlights the importance of remaining cognizant of varicella zoster virus as a cause of meningitis in not only the elderly or immunocompromised patients but also in patients who are healthy.
Asunto(s)
Herpes Zóster/complicaciones , Herpes Zóster/diagnóstico , Herpesvirus Humano 3/aislamiento & purificación , Meningitis Aséptica/diagnóstico , Meningitis Viral/diagnóstico , Aciclovir/uso terapéutico , Antivirales/uso terapéutico , Exantema/virología , Humanos , Inmunocompetencia , Masculino , Meningitis Aséptica/tratamiento farmacológico , Meningitis Viral/tratamiento farmacológico , Persona de Mediana EdadRESUMEN
A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner's syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner's syndrome and diplopia resolved after six months. Here we present the first report of Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.
Asunto(s)
Enfermedades del Nervio Abducens/etiología , Anticuerpos Antivirales/análisis , Herpes Zóster/complicaciones , Herpesvirus Humano 3/inmunología , Síndrome de Horner/etiología , Meningitis/complicaciones , Enfermedades del Nervio Abducens/diagnóstico , Diagnóstico Diferencial , Electromiografía , Femenino , Estudios de Seguimiento , Herpes Zóster/diagnóstico , Herpes Zóster/virología , Síndrome de Horner/diagnóstico , Humanos , Imagen por Resonancia Magnética , Meningitis/diagnóstico , Meningitis/virología , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
A 55-year-old woman presented with diplopia following painful skin eruptions on the right upper extremity. On presentation, she was found to have 35 prism diopters of esotropia and an abduction limitation in the left eye. Two weeks later, she developed blepharoptosis and anisocoria with a smaller pupil in the right eye, which increased in the darkness. Cerebrospinal fluid analysis showed pleocytosis and a positive result for immunoglobulin G antibody to varicella zoster virus. She was diagnosed to have zoster meningitis with Horner's syndrome and contralateral abducens nerve palsy. After intravenous antiviral and steroid treatments, the vesicular eruptions and abducens nerve palsy improved. Horner's syndrome and diplopia resolved after six months. Here we present the first report of Horner's syndrome and contralateral abducens nerve palsy associated with zoster meningitis.
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Enfermedades del Nervio Abducens/diagnóstico , Anticuerpos Antivirales/análisis , Diagnóstico Diferencial , Electromiografía , Estudios de Seguimiento , Herpes Zóster/complicaciones , Herpesvirus Humano 3/inmunología , Síndrome de Horner/diagnóstico , Imagen por Resonancia Magnética , Meningitis/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: We report a case of herpes zoster ophthalmicus in a 7-year-old child. METHODS: A 7-year-old boy presented with acute onset of vesiculopapular rash covering his left forehead, upper eyelid, and side of the nose. He was admitted via the pediatrics clinic and was referred to ophthalmology clinic for ophthalmologic examinations. RESULTS: On admission zoster ophthalmicus was limited to his skin and conjunctiva, but the disease progressed to zoster keratitis, uveitis, and meningitis. The patient was treated with topical, oral, and intravenous acyclovir. He had an uneventful recovery and was discharged. CONCLUSIONS: We experienced a case of zoster ophthamicus and meningitis in a patient without an apparent history of chickenpox.