Risk Factors for Aseptic Meningitis in Herpes Zoster Patients

Kim, Sang-Hoon; Choi, Sungyoung; Kim, Byeong C.; Nam, Taewoo; Kim, Joon‐Tae; Lee, Seung-Han; Park, Man‐Seok; Kim, Seong J.

doi:10.5021/ad.2017.29.3.283

Cited by 14 publications

(12 citation statements)

References 21 publications

(22 reference statements)

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“…Aseptic meningitis is a relatively rare neurologic complication of HZ, occurring in approximately 0.5% of patients diagnosed with recent HZ [ 3 ]. According to a retrospective study that investigated potential risk factors for aseptic meningitis in patients with HZ [ 4 ], VZV-associated aseptic meningitis occurred more frequently in patients with skin lesions affecting the craniocervical distribution (87.5%) compared with the thoracic (12.5%), lumbar (0%), and sacral (0%) dermatomes. These observations suggest the possibility that a close anatomical distance to the involved nerves could facilitate viral invasion of the brain meninges.…”

Section: Discussionmentioning

confidence: 99%

“…Variable time periods have been reported between the onset of HZ and the symptoms of meningitis, ranging from 1 to 9 days after the initiation of antiviral therapy [ 6 ]. Kim et al [ 4 ] reported that the mean interval was 5.3 days and suggested that symptoms of meningitis appeared within 6 days from onset of HZ lesions. Given that patients with HZ are usually treated with ACV at a dose of 5–10 mg/kg body weight 3 times daily for at least 7 days, many patients are likely to develop aseptic meningitis during antiviral therapy.…”

Section: Discussionmentioning

confidence: 99%

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Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

2021

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Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

2021

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“…9 The infection of the meninges has a clinical presentation easy to recognize and is more common than myelitis in the immunocompetent population. 9,10 The HZ myelitis, besides being rarer than meningitis, tends to be harder to suspect due to the clinical presentation, which tends to be atypical in patients with decreased immune function. 10 HZ myelitis usually manifests as an acute onset of sensory loss, focal weakness, and sphincter dysfunction (bladder dysfunction being more common than bowel) below the affected level.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 The HZ myelitis, besides being rarer than meningitis, tends to be harder to suspect due to the clinical presentation, which tends to be atypical in patients with decreased immune function. 10 HZ myelitis usually manifests as an acute onset of sensory loss, focal weakness, and sphincter dysfunction (bladder dysfunction being more common than bowel) below the affected level. 10 Immunocompromised patients tend to have atypical presentations of Herpes Zoster, even without the appearance of characteristic herpetic skin lesions and may show a variation in the temporal relationship between these lesions and the medullary symptoms (usually 1-2 weeks).…”

Section: Discussionmentioning

confidence: 99%

“…10 HZ myelitis usually manifests as an acute onset of sensory loss, focal weakness, and sphincter dysfunction (bladder dysfunction being more common than bowel) below the affected level. 10 Immunocompromised patients tend to have atypical presentations of Herpes Zoster, even without the appearance of characteristic herpetic skin lesions and may show a variation in the temporal relationship between these lesions and the medullary symptoms (usually 1-2 weeks). 10 However, the frequency of topographic dissociation between the affected dermatomes and the level of the myelitis is not significantly different with immunocompetent patients.…”

Section: Discussionmentioning

confidence: 99%

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A Case Report of Acute Severe Myelitis and Meningitis Secondary to Varicella Zoster Virus Reactivation in a Patient with Acquired Immunodeficiency Syndrome

Novelo-Hernández

M²,

Torres-González

et al. 2021

Int J Med Students

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Background: Myelitis post Herpes-Zoster is a rare condition that is typically associated with immunocompromised states. It usually starts as an acute loss of sensory and motor functions below the affected spinal cord level. The condition can range in severity from a mild to a fatal presentation. Other neurological complications include meningitis, atypical presentations should encourage the search for undiagnosed immunosuppression states. The Case: We describe the case of a 42-year-old man, previously undiagnosed with HIV, who developed acute myelitis and meningitis after the appearance of the classic zoster lesions. On lumbar puncture and subsequent CSF analysis, the patient was found to have Froin’s Syndrome. The patient was initiated with ceftriaxone, vancomycin, and acyclovir regimen and prophylactic antiphymic treatment was also added. After 14 days in the hospital, the fever, headache, and neck stiffness subsided while the sphincter function and lower limb paraplegia did not improve. Conclusion: Varicella zoster virus reactivation suggests underlying immunosuppression. This case demonstrates the importance of being cognizant to the wide range of clinical manifestations that may suggest spinal cord involvement after clinical reactivation. Furthermore, physicians also need to be mindful that Acquired Immunodeficiency Syndrome (AIDS) and other immunodeficiency states could present with atypical clinical manifestations.

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Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid

et al. 2022

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Background VZV infection can involve every level of the neurologic system: from the central nervous system (CNS) to the peripheral nervous system (PNS), including aseptic meningitis. Prognosis seems to differ between these neurological involvements. Prognostic factors remain unknown. Methods This is a retrospective multicenter study including all patients with a positive VZV polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF) from eight centers in Paris (France) between 2011 and 2018. Unfavorable outcome was defined as mortality linked to VZV or incomplete recovery. Modified Rankin Scale (mRS) evaluated disability before and after the infection, with the difference designated as Rankin Delta. Results Seventy‐two patients were included (53% male, median age 51 years, median mRS 0). Immunosuppression was reported in 42%. The clinical spectrum included 26 cases of meningitis, 27 instances of CNS involvement, 16 of PNS involvement, and 3 isolated replications (positive PCR but no criteria for neurological complications from VZV). Antiviral treatment was administered to 69 patients (96%). Sixty‐two patients completed follow‐up. Death linked to VZV occurred in eight cases. Unfavorable outcome (UO) occurred in 60% and was significantly associated with a higher prior mRS (Odd‐ratio (OR) 3.1 [1.4–8.8] p = .012) and the presence of PNS or CNS manifestations (OR 22 [4–181] p = .001, OR 6.2 [1.3–33] p = .03, respectively, compared to meningitis). In the CSF, higher protein level (p < .0001) was also significantly associated with a higher Rankin Delta. Conclusions Neurological complications of VZV with evidence of CSF viral replication are heterogeneous: aseptic meningitis has a good prognosis, whereas presence of CNS and PNS involvement is associated with a higher risk of mortality and of sequelae, respectively.

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Risk Factors for Aseptic Meningitis in Herpes Zoster Patients

Cited by 14 publications

References 21 publications

Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

Varicella Zoster Virus-Associated Meningitis as a Rebound Varicella Zoster Disease after Antiviral Discontinuation

A Case Report of Acute Severe Myelitis and Meningitis Secondary to Varicella Zoster Virus Reactivation in a Patient with Acquired Immunodeficiency Syndrome

Neurological complications of varicella zoster virus reactivation: Prognosis, diagnosis, and treatment of 72 patients with positive PCR in the cerebrospinal fluid

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