Varicella‐zoster virus myelitis

Abstract

We report four cases of varicella-zoster virus (VZV)-associated myelopathy in adults. Myelopathy was remitting-exacerbating in two remarkable instances, once acute and once chronic. VZV myelopathy was diagnosed based on the close temporal relationship between rash and onset of myelopathy, and for the first time, by polymerase chain reaction, which revealed VZV DNA in the cerebral spinal fluid of three patients with pleocytosis weeks to months later. Magnetic resonance imaging was abnormal in three of four patients. Although all four patients were treated at some time with intravenous acyclovir, concomitant treatment with steroids and the presence of acquired immunodeficiency syndrome in one patient prevented conclusions about a favorable response to therapy. Myelopathy after VZV infection may be remitting-exacerbating in addition to acute or chronic. Detection of VZV DNA in cerebral spinal fluid months after rash was useful for diagnosis and suggests a role for virus in the pathogenesis of myelopathy.

Varicella zoster virus infection

“…Notable exceptions include the following characteristics: atypical rashes, such as disseminated zoster or a minimal or absent dermatomal rash; zosteriform herpes simplex; modified (breakthrough) varicella in vaccinated individuals; and rashes caused by enteroviruses, poxviruses, rickettsia, drug reactions or contact dermatitis; and VZV infection in the absence of a rash. The latter includes, for example, zoster without rash (known as zoster sine herpete, sometimes with or without facial palsy 90 ), meningitis 1,91,92 , stroke 81,[93][94][95][96][97] , myelitis 98 and enteric (gastrointestinal) infections 45,[99][100][101][102] . In these settings, rapid diagnosis is necessary to plan appropriate therapy and public health measures.…”

Central nervous system infectious diseases mimicking multiple sclerosis: recognizing distinguishable features using MRI

“…As in the brainstem, changes are associated with the nerve's apparent origin in the nervous system and are most severe at the dorsal root entry zone and posterior horn of the involved dermatome. Additionally, the MRI may show a variable imaging presentation, including single or multiple lesions, with or without Gd enhancement, usually associated with marked edema 30 . CMV infection is rare in the immunocompetent patient, and imaging usually shows conus medullaris impairment associated with thickening, clumping, and enhancement of nerve roots and leptomeninges, often with associated long-segment cord high signal on T2 ( Figure 10 Another especially different manifestation of viral diseases is observed in the picornavirus family (poliovirus, enterovirus 71 and, less commonly, Coxsackie virus A and B) and in some flaviviruses, including the West Nile and dengue viruses.…”

Acute meningoencephalomyelitis due to varicella-zoster virus in an AIDS patient: report of a case and review of the literature

“…VZV-associated myelitis is rare and occurs in less than 1/1,000 cases 4,7 . The pathogenic mechanisms of VZV spinal cord compromise include neuronal and glial direct infection, vasculitis, and immune-mediated demyelination [8][9] .…”

“…Clinical outcomes range from complete recovery to death generally associated with ascending myelitis or super infections. VZV-associated myelitis is related with a high mortality in immunocompromised patients 9 . If VZV-related myelitis is often diagnosed in relationship with maculovesicular exanthema, the detection of VZV DNA in CSF can be possible in the absence of rash 10 .…”

“…Generally, CNS involvement is simultaneous with cutaneous lesions. However, infectologists should consider that the presence of VZV DNA in CSF should be in accordance with other and simultaneous HIV-related neurological complications [9][10] .…”