Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 26, 2021; 9(33): 10308-10314
Published online Nov 26, 2021. doi: 10.12998/wjcc.v9.i33.10308
Transverse myelitis after infection with varicella zoster virus in patient with normal immunity: A case report
Daehun Yun, Soo Young Cho, Wan Ju, Eun Hyoung Seo
Daehun Yun, Soo Young Cho, Wan Ju, Eun Hyoung Seo, Department of Anesthesiology and Pain Medicine, Kwangju Christian Hospital, Gwangju 61661, South Korea
Author contributions: Yun DH and Seo EH cared for the patient, conceived and designed the case report, and wrote the manuscript; Yun DH, Cho SY and Ju W edited the manuscript; Cho SY and Ju W supervised the work; all authors read and approved 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 conflicts 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: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daehun Yun, MD, Doctor, Department of Anesthesiology and Pain Medicine, Kwangju Christian Hospital, No. 37 Yangnim-ro, Nam-gu, Gwangju 61661, South Korea. squall12@naver.com
Received: July 6, 2021
Peer-review started: July 6, 2021
First decision: August 18, 2021
Revised: August 21, 2021
Accepted: September 22, 2021
Article in press: September 22, 2021
Published online: November 26, 2021
Processing time: 139 Days and 8.2 Hours
Abstract
BACKGROUND

Varicella zoster virus (VZV) is a human neurotropic and double-stranded DNA alpha-herpes virus. Primary infection with VZV usually occurs during childhood, manifesting as chickenpox. Reactivation of latent VZV can lead to various neurological complications, including transverse myelitis (TM); although cases of the latter are very rare, particularly in newly active VZV infection.

CASE SUMMARY

We report here an unusual case of TM in a middle-aged adult immunocompetent patient that developed concomitant to an active VZV infection. The 46-year-old male presented with painful vesicular eruption on his left chest that had steadily progressed to involvement of his back over a 3-d period. Cerebrospinal fluid testing was denied, but findings from magnetic resonance imaging and collective symptomology indicated TM. He was administered antiviral drugs and corticosteroids immediately but his symptom improvement waxed and waned, necessitating multiple hospital admissions. After about a month of repeated treatments, he was deemed sufficiently improved for hospital discharge to home.

CONCLUSION

VZV myelitis should be suspected when a patient visits the outpatient pain clinic with herpes zoster showing neurological symptoms.

Keywords: Herpes zoster; Postherpetic neuralgia; Transverse myelitis; Varicella zoster virus; Motor weakness; Vesicular; Pain; Case report

Core Tip: The occurrence of transverse myelitis (TM) secondary to varicella zoster virus (VZV) in immunocompetent patients is very rare. VZV-TM should be suspected when a patient visits an outpatient pain clinic with herpes zoster and presents neurological symptom(s). VZV-TM must be diagnosed early, by magnetic resonance imaging and/or cerebrospinal fluid analysis, since delayed intervention may allow for serious complications to develop. Also, early administration of a combination of antiviral drugs and corticosteroids may help resolve the condition and relieve the associated pain experienced by patients with TM secondary to VZV.