Another case of virologically confirmed zoster sine herpete, with electrophysiologic correlation

Amlie‐Lefond, Catherine; Mackin, Glenn A.; Ferguson, Michelle; Wright, Roy R.; Mahalingam, Ravi; Gilden, Donald H.

doi:10.3109/13550289609146547

Cited by 26 publications

(14 citation statements)

References 7 publications

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“…Several types of neuropathy have been reported, including acute trigeminal neuralgia, 10 multiple cranial neuropathies, 11 acute polyneuritis, 11 cauda equina syndrome with third, sixth and seventh cranial nerves palsies, 12 facial palsy, 13 recurrent thoracic radicular pain 14 and prolonged thoracic radicular pain. 15 Diagnosis of the most recent cases has been confirmed by PCR.…”

Section: Discussionmentioning

confidence: 88%

Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system

Grégoire

2006

Journal of Neurology, Neurosurgery & Psychiatry

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Objective: To study cerebrospinal fluid (CSF) and serum samples from 34 consecutive patients suspected of having varicella-zoster virus (VZV) infection of the central nervous system (CNS). Population and methods: The patients were divided into three groups. The first group consisted of 27 patients with a rash in one to three dermatomes and clinical suspicion of meningitis and radiculitis; among them, three subgroups were distinguished according to the affected dermatome: ophthalmicus (n = 9), oticus (n = 11) and cervico-thoraco-lumbar zoster (n = 7). Four cases of zoster sine herpete (ZSH) were included in the second group: these patients presented with either radiculitis (n = 2) or meningoencephalitis (n = 2), without cutaneous eruption. The third group consisted of three patients with a generalised rash and encephalitis. A polymerase chain reaction (PCR) for VZV DNA and antigen-driven immunoblots for oligoclonal anti-VZV antibodies were carried out on all CSF samples. Results: PCR of the CSF was positive in 44% of the patients from the first group, mainly within the first 7 days after eruption. In addition, intrathecal synthesis of anti-VZV antibodies was detected in 37% of patients, always after an interval of 7 days (p,0.0001). Among the four patients with ZSH, a positive VZV PCR was detected in three patients and CSF-specific oligoclonal anti-VZV antibodies in two. PCR was also positive in the CSF of two of the three patients with generalised rash and encephalitis; local production of anti-VZV antibodies was seen in a second CSF sample in one patient, and was also present in the third patient. Conclusion: Amplification of VZV DNA by PCR in the CSF and antigen-driven immunoblots have important diagnostic value in suspected VZV infection, although their presence depends on the timing of the CSF sampling. VZV is thought to be a causative agent in unexplained cases of meningitis associated with radiculitis or focal CNS symptoms, even in the absence of skin manifestations. In such patients, rapid diagnosis by this combined approach permits early antiviral treatment.

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Section: Discussionmentioning

confidence: 88%

Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system

Grégoire

2006

Journal of Neurology, Neurosurgery & Psychiatry

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“…The first two virologically confirmed cases of zoster sine herpete were verified by detection of VZV DNA in CSF (Gilden et al, 1994b). A third case of thoracic distribution zoster sine herpete, in which electromyography of paraspinal muscles demonstrated frequent fibrillation potentials restricted to chronically painful thoracic root segments, was confirmed by detection of VZV DNA in blood MNCs and anti-VZV IgG antibody in CSF (Amlie-Lefond et al, 1996). In a recent report of a patient with zoster sine herpete, the CSF did not contain amplifiable VZV DNA, but did contain anti-VZV IgG with reduced serum/CSF ratios of anti-VZV IgG indicative of intrathecal synthesis (Blumenthal et al, 2011).…”

Section: Neurologic Complications Of Zostermentioning

confidence: 95%

“…The detection of anti-VZV IgG antibody in CSF with intrathecal synthesis is superior to detection of VZV DNA in CSF to diagnose VZV vasculopathy (Nagel et al, 2007), as well as to establish the diagnosis of recurrent VZV myelopathy, VZV brainstem encephalitis, and VZV vasculopathy (Haug et al, 2010) and, most recently, to confirm the diagnosis of zoster sine herpete (Blumenthal et al, 2011). In 2 patients with zoster sine herpete, VZV DNA was found not only in CSF, but also in blood MNCs (Gilden et al, 1994b; Amlie-Lefond et al, 1996). …”

Section: Diagnostic Testsmentioning

confidence: 99%

Varicella-zoster

Gilden

Nagel

Cohrs

2014

Handbook of Clinical Neurology

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“…Amlie-Lefond et al 2 described a case of thoracic distribution zoster sine herpete confirmed by EMG and virologic testing.…”

Section: Zoster Sine Herpetementioning

confidence: 97%

Zoster Sine Herpete with Thoracic Motor Paralysis Temporally Associated with Thoracic Epidural Steroid Injection

Schuchmann

McAllister

Armstrong

et al. 2008

American Journal of Physical Medicine &Amp; Rehabilitation

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Reactivation of latent varicella-zoster virus can occur when the immune system is weakened leading to the typical presentation seen with herpes zoster or shingles. In a small percentage of these patients, motor paralysis can be seen in the affected myotomal distribution. Zoster sine herpete, or shingles without the typical vesicular rash, is an uncommon variant of zoster. Systemic steroids are known to weaken the immune response. Two previous case reports have implicated epidural steroid injections as a precipitating cause of zoster. We present a case of serologically verified zoster sine herpete producing an abdominal wall bulge, which occurred 1 wk after thoracic epidural steroid injection. Electromyography documented the presence of abdominal wall denervation. Given the low incidence of serologically proven zoster sine herpete--especially with thoracic motor paralysis--and the equally rarely documented incidence of zoster related to epidural steroids, we present what we believe to be the first reported case of zoster sine herpete with a neuropathic abdominal wall bulge occurring in close temporal association to receiving epidural steroids.

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Another case of virologically confirmed zoster sine herpete, with electrophysiologic correlation

Cited by 26 publications

References 7 publications

Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system

Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system

Varicella-zoster

Zoster Sine Herpete with Thoracic Motor Paralysis Temporally Associated with Thoracic Epidural Steroid Injection

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