Meningoencephalomyelitis with vasculitis due to varicella zoster virus: a case report and review of the literature.
Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and Brown-Sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. Autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. Polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis.
McKelvie
Penelope A
PA
Department of Anatomical Pathology, St Vincent's Hospital, Fitzroy, Victoria, Australia. mckelvpa@svhm.org.au
Collins
Steven
S
Thyagarajan
Dominic
D
Trost
Nicholas
N
Sheorey
Harsha
H
Byrne
Edward
E
D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D001921:Brain / Q000473:pathology; D004279:DNA, Viral / Q000134:cerebrospinal fluid; D003711:Demyelinating Diseases / Q000209:etiology / Q000473:pathology / Q000821:virology; D018792:Encephalitis, Viral / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D017809:Fatal Outcome; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008590:Meningoencephalitis / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D016133:Polymerase Chain Reaction; D013116:Spinal Cord / Q000473:pathology; D020293:Vasculitis, Central Nervous System / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*
D000998:Antiviral Agents; D004279:DNA, Viral; D000212:Acyclovir