Varicella-zoster virus-associated meningitis, encephalitis, and myelitis with sporadic skin blisters: A case report

Table 1 Results of cerebrospinal fluid analysis on admission

Parameter	Patient’s value	Reference value
Color	Light yellow	Clear
Xanthochromia	Positive	Negative
Cell count (cells/μL)	484	0–3
Monocyte count (cells/μL)	448	0–3
Neutrophil count (cells/μL)	36	0–3
Total protein (mg/dL)	788	10–40
Glucose (mg/dL)	111	50–75
HSV antibody titer (CFT)	Negative	Negative
HSV-DNA (PCR) (copies/mL)	Negative	Negative
VZV antibody titer (CFT)	4	Negative
VZV-DNA (PCR) (copies/mL)	1.4 × 106	Negative

CFT: Complement fixation test; HSV: Herpes simplex virus; PCR: Polymerase chain reaction; VZV: Varicella-zoster virus.

Table 2 The patient’s clinical course

Day	1	9	16	23
CSF cell count (cells/μL)	484	112	119	29
CSF VZV antibody titer (CFT)	4		32
CSF VZV-DNA (PCR) (copies/mL)	1.4 × 106	3.2 × 102	(-)	(-)
Serum VZV-IgM (EIA)	0.49 (-)	0.95 (±)	0.44 (-)
Serum VZV-IgG (EIA)	75.9 (+)	> 128 (+)	> 128 (+)

CSF: Cerebrospinal fluid; VZV: Varicella-zoster virus; CFT: Complement fixation test; PCR: Polymerase chain reaction; IgM: Immunoglobulin M; EIA: Enzyme immunoassay; IgG: Immunoglobulin G.

Table 3 Summary of studies on VZV-associated meningitis, encephalitis, and myelitis

Case	First Author (yr)	Ref	Age (yr)	Sex	Underlying diseases	Rash	Treatment	Outcome
1	Mancardi (1987)	8	32	F	None	None	Acyclovir	Survived
2	Kleinschmidt-DeMasters (1996)	9	69	F	Steroid dependent asthma	C8-Th3 distribution zoster	Not reported	Died
3	Kleinschmidt-DeMasters (1996)	9	36	M	HIV	None	Not reported	Died
4	Cinque (1997)	10	Not reported	Not reported	HIV	None	Acyclovir	Died
5	Sissoko (1998)	11	75	M	None	None	Acyclovir	Survived
6	Russman (2003)	12	51	F	Steroid dependent CREST syndrome	None	Acyclovir	Survived
7	Tavazzi (2008)	13	85	F	None	None	Acyclovir	Died
8	Tizazu (2020)	14	53	F	Steroid dependent SLE	None	Acyclovir	Survived
9	Takami (2021)	Present case	64	M	Mild diabetes mellitus	Four sporadic blisters	Acyclovir	Survived

HIV: Human immunodeficiency virus; SLE: Systemic lupus erythematosus; F: Female; M: Male.