Varicella-zoster virus-associated meningitis,encephalitis,and myelitis with sporadic skin blisters:A case report  

作　　者：Ken Takami Tsuneaki Kenzaka Ayako Kumabe Megumi Fukuzawa Yoko Eto Shun Nakata Katsuhiro Shinohara Kazunori Endo 

机构地区：[1]Department of Internal Medicine,Sainokuni Higashiomiya Medical Center,Saitama 331-8577,Saitama,Japan [2]Division of Community Medicine and Career Development,Kobe University Graduate School of Medicine,Kobe 652-0032,Hyogo,Japan [3]Department of Neurology,Sainokuni Higashiomiya Medical Center,Saitama 331-8577,Saitama,Japan [4]Department of Dermatology,Sainokuni Higashiomiya Medical Center,Saitama 331-8577,Saitama,Japan [5]Emergency Department,Sainokuni Higashiomiya Medical Center,Saitama 331-8577,Saitama,Japan

出　　处：《World Journal of Clinical Cases》2022年第2期717-724,共8页世界临床病例杂志

摘　　要：BACKGROUND Varicella-zoster virus(VZV)generally causes chickenpox at first infection in childhood and then establishes latent infection in the dorsal root ganglia of the spinal cord or other nerves.Virus reactivation owing to an impaired immune system causes inflammation along spinal nerves from the affected spinal segment,leading to skin manifestations(herpes zoster).Viremia and subsequent hematogenous transmission and nerve axonal transport of the virus may lead to meningitis,encephalitis,and myelitis.One such case is described in this study.CASE SUMMARY A 64-year-old man presented with dysuria,pyrexia,and progressive disturbance in consciousness.He had signs of meningeal irritation,and cerebrospinal fluid(CSF)analysis revealed marked pleocytosis with mononuclear predominance and a CSF/serum glucose ratio of 0.64.Head magnetic resonance imaging revealed hyperintense areas in the frontal lobes.He had four isolated blisters with papules and halos on his right chest,right lumbar region,and left scapular region.Infected giant cells were detected using the Tzanck test.Degenerated epidermal cells with intranuclear inclusion bodies and ballooning degeneration were present on skin biopsy.Serum VZV antibody titers suggested previous infection,and the CSF tested positive for VZV-DNA.He developed paraplegia,decreased temperature perception in the legs,urinary retention,and fecal incontinence.The patient was diagnosed with meningitis,encephalitis,and myelitis and was treated with acyclovir for 23 days and prednisolone for 14 days.Despite gradual improvement,the urinary retention and gait disturbances persisted as sequelae.CONCLUSION VZV reactivation should be considered in differential diagnoses of patients with sporadic blisters and unexplained central nervous system symptoms.

关 键 词：Varicella-zoster virus ENCEPHALITIS MENINGITIS MYELITIS Central nervous system Case report 

分 类 号：R725.1[医药卫生—儿科]