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

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).

Laryngeal zoster: two esoteric cases

<p class="abstract">Herpes zoster is a neurocutaneous disease resulting from the reactivation of varicella-zoster virus in dorsal sensory or cranial nerve ganglia. A thorough knowledge of laryngeal zoster is important to diagnose Zoster sine herpete. Case I shows polyneuritic involvement. Case II shows mononeuritic presentation. The clinical picture of laryngeal zoster varies from mucocutaneous lesions and paralysis to that mimicking malignancy leading to missed diagnoses.</p>

Herpes Zoster Otikus Dengan Paresis Nervus Fasialis (Sindrom Ramsay Hunt) Pada Pasien Imunokompromais

Latar belakang: Sindrom Ramsay Hunt (SRH) merupakan komplikasi yang jarang terjadi pada herpes zoster. SRH dapat terjadi tanpa adanya ruam kulit (zoster sine herpete). Karena gejala-gejala ini tidak selalu muncul saat onset, sindrom ini sering salah didiagnosis. Insidensi 5/100.000 kasus pada populasi di Amerika Serikat dan meningkat pada kelompok umur di atas 60 tahun dan kondisi imunokompromais. Laporan Kasus: Laki-laki, 66 tahun, timbul plenting-plenting di daerah telinga kiri menyebar ke dada sebelah kiri sejak 8 hari sebelum dikonsulkan. Terdapat nyeri pada telinga, pendengaran berkurang, pusing berputar, wajah sebelah kiri sulit digerakkan dan sulit berbicara. Permeriksaan fisik ditemukan vesikel berkelompok dengan dasar kulit eritem dan edema, bula, erosi, krusta, konfigurasi herpetiformis, distribusi unilateral, segmental setinggi persarafan servikal 2-4. Temuan tzank test menunjukkan sel datia berinti banyak. Penatalaksanaan dengan sistemik asiklovir dan metilprednison. Pembahasan: SRH merupakan hasil reaktivasi virus varicella zoster laten diganglion genikulatum yang menyebabkan vesikel pada aurikula, otalgia dan paresis/paralisis fasialis. Mekanisme pencetus reaktivasi pada pasien ini diduga berhubungan dengan imunokompromais (keganasan). Pasien imunokompromais memiliki resiko 20-100 kali lebih besar. Pemeriksaan Tzank sesuai dengan gambaran herpes zoster. Terapi SRH yang paling disarankan adalah terapi kombinasi antivirus dan kortikosteroid. Kesimpulan: Telah dilaporkan kasus herpes zoster otikus dengan paresis nervus fasialis (Sindrom Ramsay Hunt) pada pasien imunokompromais. Hasil terapi memuaskan. Prognosis qua ad vitam ad bonam, ad sanam dubia ad malam, ad cosmeticam dubia ad bonam. Kata kunci: Sindrom Ramsay Hunt, Herpes Zoster Otikus, Paresis Nervus Fasialis, Immunokopromais. Background; Ramsay Hunt Syndrome (RHS) is a rare complication in shingles. RHS can occur without the presence of skin rash (zoster sine herpete). Because these symptoms do not always appear at onset, RHS is often misdiagnosed. The incidence of 5/100,000 cases in the US and increase in the age above 60 years and immunocompromised. Case: A 66-years-old male complaint of vesicle on the left ear spreading to left chest, since 8 days prior to the consultation. There was otalgia, dizziness, hearing impairment, difficulty in movement and speaking on the left side. Physical examination found clustered vesicle on an erythematosus and oedematous base, bullaes, erosions, crusts, in a herpetiformis configuration, unilateral distribution, in a level of 2-4 cervical nerve innervation. The Tzank test showed multinucleated giant cells. Management with systemic acyclovir and methylprednisolone. Discussion: RHS is the result of reactivation of latent varicella zoster virus in geniculate ganglion which causes vesicles in the auricle, otalgia and facial paresis / paralysis. The mechanism for triggering reactivation in these patients is immunocompromise (malignancy). Immunocompromised have a 20-100 times greater risk. Tzank results in accordance with diagnostic of herpes zoster. The most recommended therapy is combination of antiviral and corticosteroid. Conclusion: The case of herpes zoster oticus with facial nerve paresis (Ramsay Hunt Syndrome) in immunocompromised has been published. The result of therapy was satisfying. The prognosis qua ad vitam ad bonam, ad sanam dubia ad malam, ad cosmetics dubia ad bonam. Keywords: Ramsay Hunt Syndrome, Herpes Zoster Oticus, Facial Nerve Paresis, Immunokopromised.