Varicella-Zoster Meningitis With Hypoglycorrhachia in an Immunocompetent Patient Presenting With Disseminated Varicella-Zoster Infection

Purpose: To present the clinical features of a rare case of varicella zoster infection following one dose of Coronavirus Disease 2019 (COVID-19) vaccination in an elderly Asian Indian male. Methods: Retrospective observational case report. Results: A 71-year-old gentleman presented to us with complaints of reduced vision associated with redness and pain in his right eye for 1 week. On examination he revealed a right eye pan uveitis picture with circumcorneal congestion, multiple fine keratic precipitates, anterior chamber cells and flare, vitritis and widespread areas of acute retinal necrosis. His left eye was within normal limits. Ten days prior to the presentation he had received the first dose of COVID-19 vaccine following which he had developed fever for 2 days that preceded the red eye. The patient’s aqueous sample tested positive for varicella zoster virus (VZV) by nested polymerase chain reaction (PCR) method. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in reverse transcriptase polymerase chain reaction (RT-PCR) assay from the aqueous and also from the nasopharyngeal swab was negative. Conclusion and significance: To the best of our knowledge this is the earliest description of a case that has a viral reactivation following COVID-19 vaccination. Elderly people with pre-existing comorbidities, may be at a risk of both primary coronavirus infection and unconceivable risk of aberrant immune reactions leading to a different virus infection or reactivation need to be kept in mind. We present a possible link between SARS-CoV-2 virus vaccination and varicella zoster reactivation in this patient.

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RAPID DIAGNOSIS OF VARICELLA ZOSTER INFECTION USING THE POLYMERASE CHAIN REACTION

Southern Medical Journal ◽

10.1097/00007611-199109001-00066 ◽

1991 ◽

Vol 84 (Supplement) ◽

pp. 20

Author(s):

Robert Purvis ◽

Peter Rady ◽

Stephen K. Tyring

Keyword(s):

Polymerase Chain Reaction ◽

Rapid Diagnosis ◽

Chain Reaction ◽

Varicella Zoster ◽

Polymerase Chain ◽

Varicella Zoster Infection

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Herpes Zoster with Cutaneous Dissemination in a Patient 21 Years after Splenectomy for Idiopathic Thrombocytopenic Purpura

Journal of Cutaneous Medicine and Surgery ◽

10.1177/120347541201600518 ◽

2012 ◽

Vol 16 (5) ◽

pp. 368-371 ◽

Cited By ~ 2

Author(s):

Rachel A. Moquete ◽

Barry Hartman ◽

Richard D. Granstein

Keyword(s):

Herpes Zoster ◽

Herpes Simplex ◽

Idiopathic Thrombocytopenic Purpura ◽

Good Health ◽

Immunocompetent Patient ◽

Thrombocytopenic Purpura ◽

Virus Family ◽

Varicella Zoster ◽

Increased Risk ◽

History Of

Background: Varicella-zoster virus is a member of the herpes virus family that causes varicella during a primary infection and herpes zoster (HZ) when reactivated. Patients who are immunocompromised often have atypical presentations of HZ and experience complications such as multidermal involvement and dissemination. Objective: We report a case of disseminated HZ in an immunocompetent patient with a history of splenectomy for idiopathic thrombocytopenic purpura (ITP). Our 46-year-old female patient presented with a painful vesiculopapular dermatomal rash with approximately 80 other lesions diffusely spread over her body. She was in good health but had a splenectomy for ITP 21 years earlier and a history of recurrent herpes labialis. The latter led to the tentative diagnosis of a widespread herpes simplex infection. However, laboratory results confirmed a diagnosis of disseminated herpes zoster. A workup of the patient's immune status did not reveal any abnormalities other than the patient's previously noted splenectomy. Conclusions: This case adds to the two reports of patients developing cutaneous disseminated HZ several years after splenectomy. Our case serves as a reminder that patients with a history of splenectomy appear to be at increased risk for cutaneous dissemination of HZ. Renseignements de base: Le virus varicelle-zona est un virus de la famille des Herpesviridae qui cause la varicelle durant une primo-infection, et l'herpès zoster (zona) (HZ) en cas de réactivation. Les patients qui sont immunocompromis ont souvent des présentations atypiques de HZ et affichent des complications telles que la participation et la dissémination multicutanées. Objectif: Nous exposons un cas de zona disséminé chez un patient immunocompétent ayant subi une splénectomie pour traiter un purpura thrombocytopénique idiopathique (PTI). Notre patiente âgée de 46 ans présentait une éruption vésiculo-papuleuse douloureuse localisée dans une zone dermatome avec environ 80 autres lésions diffuses réparties sur son corps. Elle était en bonne santé mais avait subi une splénectomie pour traiter un PTI 21 ans plus tôt et présentait des antécédents d'épisodes récurrents d'herpès labial. Ce dernier a abouti 'a un diagnostic provisoire d'une infection généralisée par le virus herpès simplex. Cependant, les résultats des analyses de laboratoire ont confirmé un diagnostic d'herpès zoster (zona) disséminé. Une investigation de l'état immunitaire de la patiente n'a pas révélé d'anomalies autres que la splénectomie que la patiente a subie antérieurement. Conclusions: Ce cas vient s'ajouter aux deux cas de patients signalés qui ont développé un HZ disséminé plusieurs années après avoir subi une splénectomie. Notre cas sert à rappeler que les patients présentant des antécédents de splénectomie semblent être exposés à un risque accru de dissémination cutanée sous forme de HZ.

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