Varicella Zoster Virus Reactivation in Central and Peripheral Nervous Systems Following COVID-19 Vaccination in an Immunocompetent Patient

Background: Myelitis post Herpes-Zoster is a rare condition that is typically associated with immunocompromised states. It usually starts as an acute loss of sensory and motor functions below the affected spinal cord level. The condition can range in severity from a mild to a fatal presentation. Other neurological complications include meningitis, atypical presentations should encourage the search for undiagnosed immunosuppression states. The Case: We describe the case of a 42-year-old man, previously undiagnosed with HIV, who developed acute myelitis and meningitis after the appearance of the classic zoster lesions. On lumbar puncture and subsequent CSF analysis, the patient was found to have Froin’s Syndrome. The patient was initiated with ceftriaxone, vancomycin, and acyclovir regimen and prophylactic antiphymic treatment was also added. After 14 days in the hospital, the fever, headache, and neck stiffness subsided while the sphincter function and lower limb paraplegia did not improve. Conclusion: Varicella zoster virus reactivation suggests underlying immunosuppression. This case demonstrates the importance of being cognizant to the wide range of clinical manifestations that may suggest spinal cord involvement after clinical reactivation. Furthermore, physicians also need to be mindful that Acquired Immunodeficiency Syndrome (AIDS) and other immunodeficiency states could present with atypical clinical manifestations.

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Neurological Disease Produced by Varicella Zoster Virus Reactivation Without Rash

Current Topics in Microbiology and Immunology - Varicella-zoster Virus ◽

10.1007/82_2009_3 ◽

2010 ◽

pp. 243-253 ◽

Cited By ~ 43

Author(s):

Don Gilden ◽

Randall J. Cohrs ◽

Ravi Mahalingam ◽

Maria A. Nagel

Keyword(s):

Varicella Zoster Virus ◽

Neurological Disease ◽

Virus Reactivation ◽

Varicella Zoster

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Pharyngeal dysphagia due to Varicella zoster virus meningoradiculitis and full recovery: Case report and endoscopic findings

SAGE Open Medical Case Reports ◽

10.1177/2050313x18756560 ◽

2018 ◽

Vol 6 ◽

pp. 2050313X1875656

Author(s):

Paul Muhle ◽

Sonja Suntrup-Krueger ◽

Rainer Dziewas ◽

Tobias Warnecke

Keyword(s):

Varicella Zoster Virus ◽

Brain Magnetic Resonance Imaging ◽

Virus Reactivation ◽

Swallowing Function ◽

Percutaneous Gastrostomy ◽

Negative Finding ◽

Varicella Zoster ◽

Fluid Analysis ◽

Pharyngeal Dysphagia ◽

Acyclovir Treatment

Varicella zoster virus reactivation is a rare cause of pharyngeal dysphagia with long-term sequelae persisting in most cases. A 76-year-old immunocompetent woman presented with a 4-week history of dysphagia and dysphonia. Brain magnetic resonance imaging displayed a negative finding. Fiberoptic endoscopic evaluation of swallowing showed a severe dysphagia leading to a percutaneous gastrostomy eventually. Cerebrospinal fluid analysis revealed a lymphocytic pleocytosis and polymerase chain reaction amplified Varicella zoster virus DNA. Eight months after Acyclovir treatment and despite a persisting impairment of the recurrent laryngeal nerve, regular swallowing function was regained and percutaneous gastrostomy could be removed.

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Herpes zoster of the trigeminal nerve with multi-dermatomal involvement: a case report of an unusual presentation

BMC Dermatology ◽

10.1186/s12895-020-00110-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lorenzo Stefano Pelloni ◽

Raffaele Pelloni ◽

Luca Borradori

Keyword(s):

Herpes Zoster ◽

Varicella Zoster Virus ◽

Trigeminal Nerve ◽

Dna Amplification ◽

Immunocompetent Patient ◽

Varicella Zoster ◽

Burning Pain ◽

The Face ◽

Patients At Risk ◽

Trigeminal Nerves

Abstract Background Herpes zoster, also known as shingles, results from reactivation of the varicella-zoster virus. It commonly presents with burning pain and vesicular lesions with unilateral distribution and affects the thoracic and cervical sites in up to 60 and 20% of cases, respectively. The branches of the trigeminal nerves are affected in up to 20% of cases. Multidermatomal involvement of the trigeminal nerves has been only anecdotally described in immunocompetent subjects. Case presentation A 71-year-old previously healthy male presented with grouped vesicular and impetiginized lesions with crusts on the left half of the face of two-weeks duration. The lesions first developed on the left nasal tip and progressively worsened with unilateral appearance of vesicular lesions on the left forehead, face, ala nasi, nasal vestibulum and columella, as well as on the left side of hard and soft palate. The affected edematous erythematous areas corresponded to the distribution of the left ophthalmic (V1) and maxillary (V2) branches of the trigeminal nerve, including the infraorbital and nasopalatine nerves of the maxillary branch responsible for the oral cavity involvement. Viral DNA amplification by polymerase chain reaction confirmed the presence of Varicella zoster virus. The patient was started on oral valaciclovir with rapid recovery. Conclusions Among immunocompetent patients, herpes zoster is considered a self-limited localized infection. Our observation provides a rare but paradigmatic example of herpes zoster with involvement of both the ophthalmic and maxillary divisions of the trigeminal nerve in an immunocompetent patient. Immunocompetence status and age-specific screening should be warranted in case of atypical involvement and according to the patient’s history, while treatment with antiviral drugs should be rapidily initiated in patients at risk.

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