Herpes Zoster Meningitis in a Young, Immunocompetent Adult

Bateman, RM; Naples, Robin

doi:10.1016/j.jemermed.2020.12.029

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…With early suspicion for HZM, our patient was started on IV acyclovir within two days of initial symptom onset, in addition to vancomycin and ceftriaxone. A Finnish study on immunocompetent patients within one hospital estimated aseptic meningitis incidence to be at 7.6 per 100,000 patients, while approximately 8% of these patients' meningitis was a consequence of VZV infection [11]. Presentation of HZO with CST and signs of HZM makes our case incredibly rare.…”

Section: Discussionmentioning

confidence: 80%

“…Our patient was started on IV acyclovir upon initial presentation to another hospital. Apart from ocular manifestations, the most common complication is postherpetic neuralgia affecting up to 20% of patients [9], but uncommon neurological complications such as encephalitis [10], meningitis [11], and, to a lesser extent, CST [12] have been reported. Here we report a case of a 47-year-old female who presented with HZO, early signs of CST, and zoster meningitis.…”

Section: Discussionmentioning

confidence: 99%

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Management of Cavernous Sinus Thrombosis Following Herpes Zoster Ophthalmicus

Mehkri¹,

Valisno²,

Rivas³

et al. 2022

Cureus

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Herpes zoster opthalmicus (HZO) is the reactivation of latent varicella zoster virus (VZV) within the ophthalmic branch of the trigeminal ganglion (V1). Common complications are postherpetic neuralgia and vasculopathy. Here, we report a rare case of a 47-year-old female presenting with HZO and aseptic cavernous sinus thrombosis (CST). Early screening for rare and deadly complications such as CST using CT cerebral venography (CTV) and magnetic resonance venography (MRV), as was done, is crucial to detection at earlier stages when intervention is most effective. Anticoagulation therapy was promptly started, and the patient's symptoms continued to improve during the hospital stay.

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Section: Discussionmentioning

confidence: 80%

Section: Discussionmentioning

confidence: 99%

Management of Cavernous Sinus Thrombosis Following Herpes Zoster Ophthalmicus

Mehkri¹,

Valisno²,

Rivas³

et al. 2022

Cureus

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“…This approach was shown to successfully treat a female patient previously who did not want to remain hospitalized for further IV acyclovir treatment [10] . Another case report highlights a patient who initially presented with a VZV rash and progressed to VZV meningitis despite being on 1 g valacyclovir TID [11] .…”

Section: Discussionmentioning

confidence: 99%

A case of viral meningitis due to Varicella Zoster virus infection in a young adult male

Nebeluk,

Lukin,

Alkayali

et al. 2023

IDCases

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“…The general recommendation for the treatment of VZV infection in immunocompetent patients is an initiation of antivirals within 72 hours of symptom onset or if new lesions continue to emerge [ 6 ]. Studies have demonstrated that oral valacyclovir has a higher bioavailability, better CSF penetration, and requires less frequent doses in comparison to oral acyclovir, thus it has become the oral antiviral of choice [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Our patient was initiated on oral valacyclovir on day three of symptoms according to the standard herpes zoster dosage despite which he went on to develop meningitis two days later. Another case report also outlines a patient who developed meningitis following herpes zoster two days after being started on a standard dosage of oral valacyclovir [ 6 ]. Other case reports have demonstrated successful management of VZV meningitis with oral valacyclovir however, in both cases the patient first received intravenous acyclovir followed by a higher than standard dosage of oral valacyclovir [ 2 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

Varicella Zoster Meningitis in a Young, Immunocompetent Patient Despite Initiation of Antiviral Therapy

Chirumamilla,

Ajmal,

Subedi

et al. 2023

Cureus

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Varicella zoster virus (VZV) reactivation, also known as herpes zoster is common in older adults and immunocompromised individuals and often causes a painful, vesicular rash limited to a dermatomal distribution. On occasion, it can lead to various neurological complications as well. Here we present the case of a young, immunocompetent male in his 20's with a history of primary varicella infection who presented with complaints of a painful rash in the S3-S4 dermatomal distribution. Despite being initiated on the standard oral antiviral dose for two days, he developed a headache and neck stiffness. He was diagnosed with VZV meningitis through the lumbar puncture and cerebrospinal fluid polymerase chain reaction (PCR) assay analysis. The patient reported significant improvement in symptoms following intravenous acyclovir and was discharged with additional oral valacyclovir at a higher-than-standard dosage. Our case highlights that even in relatively low-risk patients, physicians must maintain a high level of clinical suspicion for the complications of VZV reactivation even after beginning the oral antiviral medication.

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Herpes Zoster Meningitis in a Young, Immunocompetent Adult

Cited by 5 publications

References 17 publications

Management of Cavernous Sinus Thrombosis Following Herpes Zoster Ophthalmicus

Management of Cavernous Sinus Thrombosis Following Herpes Zoster Ophthalmicus

A case of viral meningitis due to Varicella Zoster virus infection in a young adult male

Varicella Zoster Meningitis in a Young, Immunocompetent Patient Despite Initiation of Antiviral Therapy

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