Varicella Zoster Aseptic Meningitis Presenting as an Atypical Mucocutaneous Eruption Involving All Three Divisions of the Trigeminal Nerve

Abstract Background Aseptic meningitis can be caused by an array of microorganisms, both bacterial and non-bacterial, as well as non-infectious conditions. Some etiologies of aseptic meningitis require treatment with antibiotics, antiviral, antifungals, anti-parasitic agents, immunosuppressants, and or chemotherapy. There are limited diagnostic tools for diagnosing certain types of aseptic meningitis, therefore knowing the differential causes of aseptic meningitis, and their relative percentages may assist in diagnosis. Review of the literature reveals that there are no recent studies of etiologies of aseptic meningitis in the United States (US). This is an epidemiologic study to delineate etiologies of aseptic meningitis in a large database of 185 HCA hospitals across the US. Methods Data was collected from January 2016 to December 2019 on all patients diagnosed with meningitis. CSF PCR studies, and CSF antibody tests were then selected for inclusion. Results Total number of encounters were 3,149 hospitalizations. Total number of individual labs analyzed was 10,613, and of these 262 etiologies were identified. 23.6% (62) of cases were due to enterovirus, 18.7% (49) due to HSV-2, 14.5% (38) due to West Nile virus, 13.7% (36) due to Varicella zoster (VZV), 10.5% (27) due to Cryptococcus. Additionally, we analyzed the rate of positive test results by region. Nationally, 9.7% of tests ordered for enterovirus were positive. In contrast, 0.5% of tests ordered for HSV 1 were positive. The southeastern United States had the highest rate of positive tests for HSV 2 (7% of tests ordered for HSV 2 were positive). The central United States had the highest rate of positive test for West Nile virus (11% of tests ordered for West Nile were positive). The northeastern region and the highest rate of positive tests for varicella zoster (18%). Table 1: Percentage of positive CSF tests (positive tests/tests ordered) Table 2: Lists the number of HIV patients and transplant patients that had positive CSF PCR/serologies Figure 1: Percentage of positive CSF tests in each region Conclusion Approximately 40% of aseptic meningitis population had treatable etiologies. A third of the Cryptococcus meningitis population had HIV. Furthermore, enteroviruses had the majority of cases within the US, which are similar to studies done in other parts of the world. Disclosures All Authors: No reported disclosures

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Varicella Zoster Virus Causing Aseptic Meningitis Without Fever or Rash in an Immunocompetent Patient

American Journal of Infectious Diseases ◽

10.3844/ajidsp.2020.55.59 ◽

2020 ◽

Vol 16 (2) ◽

pp. 55-59

Author(s):

Fazal I Raziq

Keyword(s):

Varicella Zoster Virus ◽

Aseptic Meningitis ◽

Immunocompetent Patient ◽

Varicella Zoster

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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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Aseptic meningitis caused by the Varicella-zoster virus after primary infection in an immunocompetent child: a case report

Annales de biologie clinique ◽

10.1684/abc.2018.1331 ◽

2018 ◽

Vol 76 (2) ◽

pp. 234-236

Author(s):

Claudie Lamoureux ◽

Charlotte Flatrès ◽

Sophie Vallet ◽

Adissa Tran - Minoui ◽

Christopher Payan ◽

...

Keyword(s):

Case Report ◽

Varicella Zoster Virus ◽

Aseptic Meningitis ◽

Primary Infection ◽

Varicella Zoster ◽

Immunocompetent Child

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Herpes Zoster Infection Presenting as Aseptic Meningitis and Dermatomal Rash in Immunocompetent Adult

Case Reports in Infectious Diseases ◽

10.1155/2020/8571958 ◽

2020 ◽

Vol 2020 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Suyash Dawadi ◽

Sudesh Lamsal ◽

Bhupendra Shah

Keyword(s):

Herpes Zoster ◽

Varicella Zoster Virus ◽

Aseptic Meningitis ◽

Elderly Population ◽

Virus Reactivation ◽

Herpes Zoster Infection ◽

Immunocompetent Adult ◽

Varicella Zoster ◽

Vesicular Rash ◽

Immunocompromised Status

Herpes zoster is a localized, painful, and vesicular rash involving one or adjacent dermatomes caused by varicella-zoster virus reactivation. Herpes zoster presenting as aseptic meningitis is prevalent among elderly population and people with immunocompromised status. However, it is a rare phenomenon in the young immunocompetent adult; hence, we are reporting a case of a herpes zoster infection presenting as aseptic meningitis and dermatological manifestation in a 19-year-old immunocompetent male.

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Aseptic meningitis caused by Teflon implantation for microvascular decompression

Journal of Neurosurgery ◽

10.3171/jns.1999.90.1.0145 ◽

1999 ◽

Vol 90 (1) ◽

pp. 145-147 ◽

Cited By ~ 12

Author(s):

Miroslav P. Bobek ◽

Oren Sagher

Keyword(s):

Pain Relief ◽

Trigeminal Neuralgia ◽

Aseptic Meningitis ◽

Trigeminal Nerve ◽

Microvascular Decompression ◽

Surgical Removal ◽

Content Type ◽

Initial Surgery ◽

Fine Print

✓ The authors present the case of a 47-year-old man who, after undergoing microvascular decompression for trigeminal neuralgia, experienced symptomatic pain relief but developed prolonged aseptic meningitis. This case is unusual in that the patient remained dependent on steroid medications for nearly 5 months following the initial surgery and the aseptic meningitis did not resolve until after surgical removal of the Teflon used to pad the trigeminal nerve. The pathophysiological characteristics of the body's reaction to implanted Teflon are discussed along with the rationale for removing this substance in cases of prolonged intractable aseptic meningitis.

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Clinical, epidemiological and etiological studies of adult aseptic meningitis: Report of 11 cases with varicella zoster virus meningitis

Rinsho Shinkeigaku ◽

10.5692/clinicalneurol.cn-001054 ◽

2017 ◽

Vol 57 (9) ◽

pp. 492-498 ◽

Cited By ~ 3

Author(s):

Shinichi Takeshima ◽

Yuji Shiga ◽

Takahiro Himeno ◽

Keisuke Tachiyama ◽

Teppei Kamimura ◽

...

Keyword(s):

Varicella Zoster Virus ◽

Aseptic Meningitis ◽

Varicella Zoster

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A Pediatric Case of Relapsing-Remitting Multiple Sclerosis Onset following Varicella Zoster Ophthalmicus with Optic Neuritis

Case Reports in Pediatrics ◽

10.1155/2018/6931206 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4

Author(s):

Naoko Shiba ◽

Yuji Inaba ◽

Mitsuo Motobayashi ◽

Makoto Nishioka ◽

Yoichiro Kawasaki ◽

...

Keyword(s):

Multiple Sclerosis ◽

Herpes Zoster ◽

Optic Neuritis ◽

Trigeminal Nerve ◽

Present Report ◽

Epidemiological Studies ◽

Herpes Zoster Ophthalmicus ◽

Varicella Zoster ◽

Relapsing Remitting ◽

Relapsing Remitting Multiple Sclerosis

Some epidemiological studies have implied a pathogenetic association between varicella zoster virus (VZV) and multiple sclerosis (MS); this, however, remains controversial. The present report describes a case involving an immunocompetent 10-year-old girl who developed relapsing-remitting MS following the prolonged reactivation of VZV inside the first branch of the trigeminal nerve, exhibiting herpes zoster ophthalmicus with severe optic neuritis. Symptoms related to herpes zoster ophthalmicus and MS appeared consecutively in the 10-week period after the appearance of vesicles. This suggests that the onset of MS was triggered by some mechanism involving VZV reactivation in the first branch of the trigeminal nerve. To the best of our knowledge, this report is the first to describe a relationship between the onset of MS and herpes zoster ophthalmicus. Early diagnosis and aggressive antiviral therapy are important in cases of herpes zoster ophthalmicus to prevent the possible development of MS as well as visual impairment as sequela.

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Case report: aseptic meningitis secondary to varicella-zoster virus (VZV) without an exanthem post MMR vaccination

BMC Infectious Diseases ◽

10.1186/s12879-021-06453-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Syeda Sahra ◽

Abdullah Jahangir ◽

Allison Glaser ◽

Neville Mobarakai ◽

Ahmad Jahangir

Keyword(s):

Case Report ◽

Varicella Zoster Virus ◽

Aseptic Meningitis ◽

Immunocompetent Patient ◽

Mmr Vaccine ◽

Case Presentation ◽

Varicella Zoster ◽

Zoster Sine Herpete ◽

History Of

Abstract Background Varicella-zoster virus (VZV) is a known cause of aseptic meningitis, with a predisposition for an immunocompromised population. A dermatomal rash usually accompanies aseptic meningitis secondary to VZV. Case presentation We report the case of a 31-year-old male with a history of chickenpox in childhood and recent shingles who presented with severe frontal headaches secondary to VZV meningitis. The patient had also recently received the measles-mumps-rubella (MMR) vaccine. He recovered without any neurological sequala. Conclusion This case report describes an immunocompetent patient with recent MMR vaccination who developed aseptic meningitis secondary to VZV without any dermatomal involvement (Zoster Sine Herpete).

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Meningitis gone viral: Description of the German Echo Wave 2013

10.21203/rs.2.11283/v1 ◽

2019 ◽

Author(s):

Jonas Graf ◽

Christian Hartmann ◽

Helmar C Lehmann ◽

Carolin Otto ◽

Ortwin Adams ◽

...

Keyword(s):

Aseptic Meningitis ◽

University Hospital ◽

Cerebrospinal Fluid Analysis ◽

Enteroviral Infection ◽

Varicella Zoster ◽

Fluid Analysis ◽

Significant Burden ◽

Simplex Virus ◽

Herpes Simplex Virus 2 ◽

The University

Abstract BACKGROUND: Aseptic meningitis epidemics may pose various health care challenges. OBJECTIVE: We describe the German enterovirus meningitis epidemics in the university hospital centers of Düsseldorf, Cologne and Berlin between January 1st and December 31st, 2013. RESULTS: A total of 72 enterovirus (EV-positive) meningitis cases were detected in our multicenter cohort, corresponding to 2.1% of all EV-positive cases which were voluntarily reported within the National Enterovirussurveillance (based on investigation of patients with suspected aseptic meningitis/encephalitis and acute flaccid paralysis) by physicians within this period of time. Among these 72 patients, 38 (52.8%) were echovirus-positive (18 pediatric and 20 adult cases, median age 18.5 years). At the same time, 45 aseptic meningitis cases in our cohort were excluded to be due to enteroviral infection (EV-negative). Three EV-negative patients were tested positive for varicella zoster virus (VZV) and one EV-negative patient for herpes simplex virus 2. Hospitalization was significantly longer in EV-negative cases. Cerebrospinal fluid analysis did not reveal significant differences between the two groups. After discharge, EV-meningitis resulted in significant burden of sick leave in our pediatric cohort as parents had to care for the children at home. CONCLUSION: Voluntary disease-specific surveillance, such as provided by the National Enterovirussurveillance in our study may be a valuable tool for epidemiological research.

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