Varicella-zoster meningitis in an immunocompetent young man presenting with a painless erythematous rash

Abstract

A 32-year-old man presented with a 7-day history of generalised headache, intermittent fever, emesis and diarrhoea. Four days after symptom onset, he developed a vesicular rash on his medial left thigh, without associated pain, paraesthesia or pruritus. He had no significant past medical history, and no HIV risk factors. He was presumed to have enteroviral meningitis and was commenced on supportive therapy. Lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed a lymphocytic pleocytosis. While awaiting CSF serology, the formation of a new vesicle was noted at the site of the rash and was swabbed. Results for both the CSF and vesicle swab returned positive for varicella-zoster virus (VZV) confirming concurrent VZV meningitis with atypical painless herpes zoster in a young immunocompetent patient. He was initiated on intravenous acyclovir and made a full recovery after 2 weeks of treatment.

Varicella-Zoster Meningitis With Hypoglycorrhachia in an Immunocompetent Patient Presenting With Disseminated Varicella-Zoster Infection

“…Immunocompromised people are at high risk due to the weakened activity of T-cell mediated immunity. Groups at risk in this category include lymphoma/leukemia patients, HIV, or people with autoimmune disease on systemic immunosuppressive therapy with chemotherapy, biologics as tumor necrosis factor (TNF), Janus kinase inhibitors (JAK2 kinase) or corticosteroids [1,2]. There have been few case reports of dermatomal distribution of VZV rash with aseptic meningitis in immunocompetent patient [3][4][5].…”