Segmental zoster paresis as a cause for persistent fever in an immunocompromised patient

2021 ◽  
Vol 14 (10) ◽  
pp. e246015
Author(s):  
Renuka Murali Govind ◽  
Yun Cao
Keyword(s):  
Varicella Zoster Virus ◽  
Immunocompromised Patient ◽  
Virus Detection ◽  
Early Investigation ◽  
Molecular Testing ◽  
Limb Weakness ◽  
Varicella Zoster ◽  
Intravenous Acyclovir ◽  
High Index Of Suspicion ◽  
Delays In Diagnosis

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.

Live zoster vaccination in an immunocompromised patient leading to death secondary to disseminated varicella zoster virus infection

Vaccine ◽  
2018 ◽  
Vol 36 (27) ◽  
pp. 3890-3893 ◽  
Author(s):  
Kate E. Alexander ◽  
Philip L. Tong ◽  
Kristine Macartney ◽  
Rohan Beresford ◽  
Vicky Sheppeard ◽  
...  
Keyword(s):  
Virus Infection ◽  
Varicella Zoster Virus ◽  
Immunocompromised Patient ◽  
Varicella Zoster Virus Infection ◽  
Varicella Zoster

scholarly journals Cutaneous Vasculitis and Central Nervous System Infarctions due to Varicella Zoster Virus Vasculopathy in an Immunocompromised Patient

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Karen Flores Rosario ◽  
Katherine C. Michelis ◽  
Carol Bjorkman ◽  
Faris G. Araj
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Varicella Zoster Virus ◽  
Immunocompromised Patient ◽  
Interesting Case ◽  
Cutaneous Vasculitis ◽  
Varicella Zoster ◽  
Vesicular Rash

Varicella zoster virus (VZV) infection commonly presents as varicella during childhood, and zoster, later in life. Here, we present a rare and interesting case of VZV infection that manifested with both cerebral and spinal infarctions and cutaneous vasculitis in the absence of a classic vesicular rash in an immunocompromised patient.

scholarly journals Anti-NMDAR encephalitis with concomitant varicella zoster virus detection and nonteratomatous malignancy

2019 ◽  
Vol 6 (2) ◽  
pp. e537
Author(s):  
Preeti A. Prakash ◽  
Jingxiao Jin ◽  
Kanwal Matharu ◽  
Tanu Garg ◽  
Wendy C. Tsai ◽  
...  
Keyword(s):  
Varicella Zoster Virus ◽  
Virus Detection ◽  
Varicella Zoster ◽  
Nmdar Encephalitis

Avoiding a lumbar puncture may be a rash decision: a case report of varicella-zoster virus-associated radiculopathy in advanced HIV infection

2019 ◽  
Vol 30 (10) ◽  
pp. 1031-1033
Author(s):  
Emma Wallis ◽  
Bahij Al-Hakim ◽  
Paul Holmes ◽  
Sam Douthwaite ◽  
Ranjababu Kulasegaram
Keyword(s):  
Varicella Zoster Virus ◽  
Lumbar Puncture ◽  
Case Reports ◽  
Response To Treatment ◽  
High Dose ◽  
Serum Samples ◽  
Cd4 Cell Count ◽  
Varicella Zoster ◽  
Intravenous Acyclovir ◽  
History Of

A 34-year-old man recently diagnosed with advanced human immunodeficiency virus infection (CD4 cell count of 139 cells/mm3), not yet started on antiretroviral medications, presented to hospital with a ten-day history of left leg weakness and difficulty walking. He described a childhood history of chickenpox with previous shingles over his buttock over three years ago. Examination revealed reduced power in the left hip and knee flexors and absent knee and adductor reflexes. Lumbar punctures were performed and polymerase chain reaction (PCR) detected varicella-zoster virus (VZV) DNA. Concurrent serum samples for VZV PCR were negative. The patient was diagnosed with VZV radiculopathy and treated with high-dose intravenous acyclovir. Within two days, neurological signs improved. Previous case reports define VZV radiculopathy by a temporal and geographical relationship with a zoster rash. Our diagnosis was based on a clinical picture of radiculopathy with virological evidence in CSF and confirmed by a dramatic clinical response to treatment. We propose that lumbar puncture and detection of VZV DNA by PCR in the cerebrospinal fluid (CSF) is an invaluable investigation that should be considered in the workup of immunosuppressed patients presenting with a radiculopathy.

scholarly journals Multi-organ involvement secondary to varicella zoster virus, herpes simplex virus and cytomegalovirus in an immunocompromised patient

2019 ◽  
Vol 12 (3) ◽  
pp. e228150 ◽  
Author(s):  
Ripal Jariwala ◽  
Kristen Zeitler ◽  
Nicole D Riddle ◽  
Chakrapol Sriaroon
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
Varicella Zoster Virus ◽  
Immunocompromised Patient ◽  
Case Reports ◽  
Skin Lesions ◽  
Viral Reactivation ◽  
Organ Involvement ◽  
Varicella Zoster ◽  
Simplex Virus

The use of immunosuppressing agents can act as a catalyst for viral reactivation, promoting systemic infection with organ involvement. Current literature remains sparse on this topic but does provide individual case reports involving single viruses. We present the case of an immunocompromised patient with skin lesions, pancreatitis, colitis and hepatitis. Work-up revealed varicella zoster virus, which likely put the patient at risk for multi-organ involvement, as well as clinical suspicion of other implicated viruses, specifically herpes simplex virus and cytomegalovirus. A high clinical index of suspicion along with biopsy guidance for viral involvement in immunocompromised patients is crucial for early diagnosis and treatment of these conditions.

scholarly journals Varicella Vaccine Meningitis as a Complication of Herpes Zoster in Twice-Immunized Immunocompetent Adolescents

2020 ◽  
Vol 35 (13) ◽  
pp. 889-895 ◽  
Author(s):  
Veena Ramachandran ◽  
Stephen C. Elliott ◽  
Kathie L. Rogers ◽  
Randall J. Cohrs ◽  
Miles Weinberger ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Herpes Zoster ◽  
Varicella Zoster Virus ◽  
Varicella Vaccine ◽  
The United States ◽  
Vaccine Virus ◽  
Virus Reactivation ◽  
Wild Type ◽  
Varicella Zoster ◽  
Intravenous Acyclovir

Varicella-zoster virus vaccination is recommended for virtually all young children in the United States, Canada, and several other countries. Varicella vaccine is a live attenuated virus that retains some of its neurotropic properties. Herpes zoster caused by vaccine virus still occurs in immunized children, although the rate is much lower than in children who had wild-type varicella. It was commonly thought that 2 varicella vaccinations would protect children against the most serious complication of meningitis following herpes zoster; however, 2 meningitis cases have already been published. We now report a third case of varicella vaccine meningitis and define risk factors shared by all 3 immunized adolescents. The diagnosis in cerebrospinal fluid in this third case was verified by amplifying and sequencing portions of the viral genome, to document fixed alleles found only in the vaccine strain. Viral antibody was also detected in the cerebrospinal fluid by confocal microscopy. When compared with the other 2 cases, remarkably all 3 were 14 years old when meningitis occurred. All 3 were treated with intravenous acyclovir, with complete recovery. The adolescent in our case report also had recurrent asthma, which was treated with both prednisone tablets and beclomethasone inhaler before onset of meningitis. When the 3 cases were considered together, they suggested that immunity to varicella-zoster virus may be waning sufficiently in some twice-immunized adolescents to make them vulnerable to varicella vaccine virus reactivation and subsequent meningitis. This complication rarely happens in children after wild-type varicella.

Varicella-Zoster Virus Limbic Encephalitis in an Immunocompromised Patient

2001 ◽  
Vol 33 (10) ◽  
pp. 786-788 ◽  
Author(s):  
Pierre Tattevin ◽  
Frédérique Schortgen ◽  
Thomas De Broucker ◽  
Sandrine Dautheville ◽  
Michel Wolff
Keyword(s):  
Varicella Zoster Virus ◽  
Limbic Encephalitis ◽  
Immunocompromised Patient ◽  
Varicella Zoster
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