Varicella-Zoster as a Cause of Aseptic Meningitis in an Immunocompetent Young Patient With Skin Rash

Abstract

We present a case of aseptic meningitis due to Varicella-Zoster infection in an immunocompetent patient. Varicella-Zoster virus (VZV) causes chickenpox disease in children, teens, and young adults. Typically, it runs its course and stays dormant in nerve tissue, which can get reactivated in elderly, immunocompromised patients. Frequently, reactivation results in the painful dermatomal rash of herpes zoster, but in sporadic cases, it can cause meningitis or encephalitis in the immunocompromised population. Our case demonstrates a healthy immunocompetent adult male who presented with headache, fever, mild neck stiffness, and painless right-sided abdominal skin rash and was later diagnosed with VZV meningitis via polymerase chain reaction (PCR) of the cerebrospinal fluid (CSF). We are reporting this case due to its rarity, and the challenging nature of its diagnosis and treatment. In the hospital, he was treated with IV acyclovir for three days and discharged home on 14 days of oral valacyclovir. Our case demonstrates the importance of having a high degree of suspicion, even if the presentation is unexpected and atypical.

Acute severe headache: Association of herpes zoster meningitis and sinus vein thrombosis

“…Early initiation of antivirals is required, since delayed or inadequate treatment may cause serious neurological complications or even death. As such, IV acyclovir of 10 mg/kg is recommended three times a day for 10-14 days for VZV meningitis [15]. Our patient was discharged in good health after 14 days of IV acyclovir treatment.…”

Varicella Zoster Aseptic Meningitis Presenting as an Atypical Mucocutaneous Eruption Involving All Three Divisions of the Trigeminal Nerve

“…The patient in this case report was found to have multi-dermatomal herpes zoster of the trigeminal nerve with disseminated disease to the central nervous system, which has not previously been reported in an immunocompetent individual. However, aseptic meningitis with an associated abdominal herpes zoster eruption has been observed, highlighting the ability of herpes zoster to present with concomitant central nervous system invasion [4]. The initial differential diagnosis in the current case was broad.…”

Ramsay Hunt syndrome with viral meningitis

“…Som komplikation i forbindelse med enhver VZV-infektion får ca. 0,5% af disse patienter viral meningitis, som kan overses, da symptomerne ikke altid forekommer [3,4]. Vi beskriver et tilfaelde med RHS hos en patient, som henvendte sig med vesikler i munden og samtidig viral meningitis.…”