Chronic varicella-zoster virus myelitis without cutaneous eruption in a patient with AIDS: report of a fatal case.
We describe a fatal case of varicella-zoster virus myelitis that was preceded by neurological symptoms for 10 months in a patient with human immunodeficiency virus infection and an extremely low CD4 cell count (20/microL). The patient was also receiving chronic acylovir therapy for suppression of herpes complex. Despite chronic unilateral periauricular and facial pain, which was later accompanied by upper- and lower-extremity weakness, a cutaneous eruption never developed. It is hypothesized that a blunted inflammatory response in the spinal cord--possibly related to a very low CD4 cell count--and long-term acylovir administration might have contributed to the atypical manifestation might have contributed to the atypical manifestation of varicella-zoster virus-related neurological disease in this immunocompromised patient.
Manian
F A
FA
Division of Infectious Diseases, St. John's Mercy Medical Center, St. Louis, Missouri 63141, USA.
Kindred
M
M
Fulling
K H
KH
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000188:drug therapy / Q000473:pathology; D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D002908:Chronic Disease; D017809:Fatal Outcome; D006562:Herpes Zoster / Q000150:complications* / Q000473:pathology / Q000821:virology; D014645:Herpesvirus 3, Human; D006801:Humans; D008297:Male; D009188:Myelitis, Transverse / Q000150:complications* / Q000473:pathology / Q000821:virology
D000212:Acyclovir