Copyright
©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Varicella-zoster virus-associated meningitis, encephalitis, and myelitis with sporadic skin blisters: A case report
Ken Takami, Tsuneaki Kenzaka, Ayako Kumabe, Megumi Fukuzawa, Yoko Eto, Shun Nakata, Katsuhiro Shinohara, Kazunori Endo
Ken Takami, Kazunori Endo, Department of Internal Medicine, Sainokuni Higashiomiya Medical Center, Saitama 331-8577, Saitama, Japan
Tsuneaki Kenzaka, Ayako Kumabe, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe 652-0032, Hyogo, Japan
Megumi Fukuzawa, Department of Neurology, Sainokuni Higashiomiya Medical Center, Saitama 331-8577, Saitama, Japan
Yoko Eto, Department of Dermatology, Sainokuni Higashiomiya Medical Center, Saitama 331-8577, Saitama, Japan
Shun Nakata, Katsuhiro Shinohara, Emergency Department, Sainokuni Higashiomiya Medical Center, Saitama 331-8577, Saitama, Japan
Author contributions: Takami K, Fukuzawa M, Eto Y, Nakata S, and Shinohara K managed the case, and prepared and revised the manuscript; Kenzaka T, Kumabe A, and Endo K assisted with the preparation and revision of the manuscript; all co-authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work; all co-authors take full responsibility for the integrity of the study and the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Tsuneaki Kenzaka, MD, PhD, Professor, Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, No. 2-1-5 Arata-cho, Hyogo-ku, Kobe 652-0032, Hyogo, Japan. smile.kenzaka@jichi.ac.jp
Received: August 18, 2021
Peer-review started: August 18, 2021
First decision: November 1, 2021
Revised: November 11, 2021
Accepted: December 11, 2021
Article in press: December 11, 2021
Published online: January 14, 2022
BACKGROUND
Varicella-zoster virus (VZV) generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves. Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment, leading to skin manifestations (herpes zoster). Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis, encephalitis, and myelitis. One such case is described in this study.
CASE SUMMARY
A 64-year-old man presented with dysuria, pyrexia, and progressive disturbance in consciousness. He had signs of meningeal irritation, and cerebrospinal fluid (CSF) analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64. Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes. He had four isolated blisters with papules and halos on his right chest, right lumbar region, and left scapular region. Infected giant cells were detected using the Tzanck test. Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy. Serum VZV antibody titers suggested previous infection, and the CSF tested positive for VZV-DNA. He developed paraplegia, decreased temperature perception in the legs, urinary retention, and fecal incontinence. The patient was diagnosed with meningitis, encephalitis, and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days. Despite gradual improvement, the urinary retention and gait disturbances persisted as sequelae.
CONCLUSION
VZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.
Core Tip: We describe a rare case of multiple central nervous system (CNS) complications following varicella zoster virus (VZV) reactivation in an immunocompetent patient with mild diabetes. He had four isolated blisters with encephalitis, meningitis, and myelitis. VZV reactivation should be considered in the differential diagnosis of patients with sporadic blisters and unexplained CNS symptoms.
