Varicella zoster virus associated-polyradiculoneuritis in an elderly woman: A new subtype of varicella zoster virus neuropathy

Abstract

An 82-year-old Japanese woman without underlying disease was admitted to our hospital 3 days after she noticed lower-limb weakness. At presentation, she had lower-leg motor paralysis with mild upper-limb paresis and left Ramsay Hunt syndrome. Cerebrospinal fluid (CSF) findings revealed moderate pleocytosis. A polymerase chain reaction for varicella zoster virus (VZV) DNA in CSF was positive. MRI using 3D Nerve-VIEW (Philips) and contrast T 1 images showed high-intensity lesions on the L2-5 and S1-2 spinal roots. A new subtype of VZV-associated polyradiculoneuritis was diagnosed in this patient. We provide the case details and compare three similar reported cases.

Herpes zoster peripheral nerve complications: Their pathophysiology in spinal ganglia and nerve roots

“…Cortese et al reported the case of a 79-year-old man with flaccid paralysis of the lower limbs without HZ rash; CSF pleocytosis and a VZV DNA PCRpositive result were detected in his CSF, and MRI findings showed cauda equina radiculopathy (17). We later reported the cases of the following three patients with VZV polyradiculoneuritis that differed from their HZ dermatomes (10)(11)(12). Patient 10, an elderly woman, presented VZV-associated polyradiculoneuritis, ascending motor paralysis in the limbs, and a CSF cell increase (21 cells/μL); VZV IgM antibody persisted, and cervical and lumbar spine MRI contrast T1WI revealed high-intensity lesions in the C7-Th1 (Figure 2C) (10) and L4-5 spinal root regions.…”

“…Patient 11 exhibited quadriplegia in the proximal lower limbs with disseminated HZ (11). Patient 12 showed VZV polyradiculoneuritis that had initially developed in the lower spinal ganglia, in which 3D NerveVIEW and MRI T1WI showed high signal intensities at the L2-4 spinal ganglia and roots (Figure 2D) (12).…”

“…We also treated an elderly woman with VZV-associated ascending quadriplegia with HZ rash on the cervical 7-8 regions, with an increase in cerebrospinal fluid (CSF) cells (10). An adult patient with VZV polyradiculoneuritis with disseminated HZ and an elderly patient with VZV-Brief Report associated polyradiculoneuritis were also treated at our hospital (11,12).…”

“…(C) Patient 10: Gd-enhanced cervical root coronary MRI T1WI showed high signals on both sides at the C6 and C7 nerve roots (right side arrows) (10). (D) Patient 12: Lumbar root coronary MRI using 3D NerveVIEW imaging showed high-intensity lesions on both sides at L2-4 spinal roots (arrows)(12). The HZ skin rash and CT/MRI images are reprinted with permission from references (7),(10), and(12).…”

“…(D) Patient 12: Lumbar root coronary MRI using 3D NerveVIEW imaging showed high-intensity lesions on both sides at L2-4 spinal roots (arrows)(12). The HZ skin rash and CT/MRI images are reprinted with permission from references (7),(10), and(12).…”