RESUMEN
The clinical manifestations of varicella-zoster virus infections can be divided into primary infection with chickenpox and reactivated infection with dermatomal shingles, disseminated herpes zoster, zoster sine herpete and varicella-zoster virus encephalitis, meningitis and vasculopathy. We present a case of zoster sine herpete leading to meningitis with cranial and peripheral nerve palsies. A 17-year-old woman was admitted to hospital with intermittent fever, drowsiness, slowness and subsequent frontal headache and horizontal diplopia. Cerebrospinal fluid examination revealed lymphocytic pleocytosis and PCR amplified varicella-zoster virus DNA. Laboratory and clinical findings were suggestive of meningoencephaloradiculoneuropathy, stemming from varicella-zoster virus and affecting cranial and peripheral nerves. Only 5% of patients with zoster develop cranial and peripheral nerve palsies. Diagnosis is imperative in order to initiate prompt antiviral therapy so as to minimize morbidity and the risk of death.
Asunto(s)
Enfermedades de los Nervios Craneales/virología , Herpesvirus Humano 3/aislamiento & purificación , Meningitis/virología , Parálisis/virología , Zoster Sine Herpete/virología , Adolescente , Enfermedades de los Nervios Craneales/inmunología , Femenino , Herpesvirus Humano 3/genética , Humanos , Inmunocompetencia , Meningitis/inmunología , Parálisis/inmunología , Zoster Sine Herpete/inmunologíaRESUMEN
Encephalitis associated with varicella-zoster virus, rare among children in the varicella vaccine era, has generally been associated with a rash. We report fatal wild-type varicella-zoster virus encephalitis without a rash in a child who had received 1 dose of varicella vaccine. Varicella-zoster virus encephalitis should be considered in the differential diagnosis for children presenting with acute neurologic symptoms, even vaccine recipients.
Asunto(s)
Vacuna contra la Varicela/administración & dosificación , Encefalitis por Varicela Zóster/patología , Herpesvirus Humano 3/aislamiento & purificación , Zoster Sine Herpete/patología , Encéfalo/patología , Preescolar , Encefalitis por Varicela Zóster/inmunología , Resultado Fatal , Femenino , Herpesvirus Humano 3/inmunología , Humanos , Imagen por Resonancia Magnética , Zoster Sine Herpete/inmunologíaAsunto(s)
Herpes Zóster/diagnóstico , Herpesvirus Humano 3/genética , Herpesvirus Humano 3/inmunología , Zoster Sine Herpete/diagnóstico , Enfermedad Crónica , ADN/líquido cefalorraquídeo , Progresión de la Enfermedad , Femenino , Herpes Zóster/líquido cefalorraquídeo , Herpes Zóster/genética , Herpes Zóster/inmunología , Herpes Zóster/virología , Humanos , Inmunoglobulina G/líquido cefalorraquídeo , Persona de Mediana Edad , Zoster Sine Herpete/líquido cefalorraquídeo , Zoster Sine Herpete/genética , Zoster Sine Herpete/inmunología , Zoster Sine Herpete/virologíaRESUMEN
Herpes zoster results from reactivation of the varicella zoster virus (VZV). Zoster sine herpete (ZSH) is an uncommon manifestation of VZV infection and presents with similar symptoms but without the vesicular rash. We describe an unusual case of lateral sinus thrombosis (LST) that developed during the clinical course of ZSH in the C2 distribution. A 55-year-old woman presented with a 3-day history of left temporal and postauricular pain, nausea, vomiting, and mild photophobia. She denied otalgia, otorrhea, and hearing loss. Examination revealed hyperesthesia in the left C2 nerve root distribution without evidence of herpetic rash. A computed tomography scan showed minimal fluid in the left mastoid cavity (not mastoiditis) and thrombus within the left lateral and sigmoid dural sinus. Magnetic resonance imaging and magnetic resonance angiogram confirmed these findings. Laboratory studies revealed elevated neurotrophic immunoglobulin G levels to VZV. Hypercoagulable studies were normal. She was subsequently treated with Neurontin, acyclovir, and anticoagulation. Her symptoms improved, and she was discharged 3 days later. LST is generally a complication of middle ear infection. Nonseptic LST, however, may result from dehydration, oral contraceptive use, coagulopathy, or thyroid disease. This unusual case raises the suspicion that thrombosis resulted from VZV associated thrombophlebitis in the ipsilateral cerebral venous sinuses along the second cervical nerve root distribution. A high index of suspicion is necessary in such cases so that a different treatment course can be identified and antiviral medication initiated promptly.
Asunto(s)
Trombosis del Seno Lateral/complicaciones , Trombosis del Seno Lateral/diagnóstico , Zoster Sine Herpete/complicaciones , Zoster Sine Herpete/tratamiento farmacológico , Técnicas de Laboratorio Clínico , Femenino , Herpesvirus Humano 3/patogenicidad , Humanos , Hiperestesia/etiología , Angiografía por Resonancia Magnética , Imagen por Resonancia Magnética , Persona de Mediana Edad , Náusea/etiología , Tomografía Computarizada por Rayos X , Vómitos/etiología , Zoster Sine Herpete/inmunologíaRESUMEN
Since experimental, herpes simplex virus-induced acute retinal necrosis (ARN) develops in mice only if the mice fail to acquire virus-specific delayed hypersensitivity (DH) and despite their production of anti-viral antibodies (i.e. ACAID), I investigated whether a similar situation exists for patients with either varicella zoster virus (VZV)-induced ARN or anterior uveitis caused by VZV. Patients with either acute VZV-induced ARN, anterior uveitis with dermatitis (herpes zoster ophthalmicus, ZO-AU), or anterior uveitis without dermatitis (zoster sine herpete, ZSH-AU) were skin-tested with VZV to evaluate DH. The formal diagnoses of ARN associated with VZV, ZO-AU, and ZSH-AU were established by PCR analysis of the ocular samples and/or by the Goldmann-Witmer coefficient to determine levels of local antibody production. ARN, ZO-AU, and ZSH-AU activity were assessed clinically, and DH skin tests were repeated three months after onset when ocular recovery had taken place. All patients with VZV-induced skin disease alone (control group) displayed intense DH when tested with VZV antigen. In contrast, subsets of patients with ARN or ZO-AU displayed loss of VZV-specific DH. Patients with the most severe ARN or ZO-AU had the lowest DH responses to VZV antigens. Serum anti-VZV antibody titers were higher in ARN patients than in normal controls, and the anti-viral titer correlated inversely with the intensity of anti-VZV DH responses. VZV-specific DH responses were restored in patients who recovered from ARN. Patients with ZSH-AU also failed to display VZV-specific DH. The absence of DH reactivity to VZV antigens (i.e. immune deviation) appears to be a concomitant feature of VZV uveitis of high intensity, implying that virus-specific DH may interfere with the emergence of VZV-induced ARN or anterior uveitis.