Atypical presentation of varicella-zoster virus encephalitis in an immunocompetent adult
Background
Varicella-zoster virus encephalitis is uncommon, but not rare, in immunocompetent adults. Typically, patients develop stroke with hemiplegia caused by large vessel vasculopathy days to weeks after herpes zoster ophthalmicus.
Method
A previously healthy 66-year-old man developed obtundation deteriorating to coma within 24 hours. He had lymphocytic meningitis and multiple bilateral edematous and hemorrhagic lesions predominantly in the white matter, and intraventricular and subarachnoid hemorrhage. Treatment with acyclovir and dexamethasone was readily administered. The diagnosis of varicella-zoster virus encephalitis was confirmed by polymerase chain reaction analysis of the cerebrospinal fluid. No zosteriform rash preceded or followed encephalitis. Two years later, the patient is in good health, and no relapse or sign of immunosuppression has been reported.
Conclusion
This is a case of varicella-zoster virus encephalitis in an immunocompetent patient presenting without typical rash and with clinicoradiologic features of multifocal encephalitis, which characterize immunosuppression.
aIntensive Care Unit, University of Thessaly, Larissa, Greece
bDepartment of Radiology, Faculty of Medicine, University of Crete, Crete, Greece.
Reprint requests: Epaminondas Zakynthinos, MD, Intensive Care Unit, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece.
ABSTRACT