[VZV-related myelitis: a pathophysiological hypothesis].
BACKGROUND
Complications of VZV infection in the central nervous system are multiple. VZV-related myelitis is an uncommon complication of herpes zoster.


METHODS
We report the case of a 55-year old man with intercostal herpes zoster who presented a subacute medullar syndrome. MRI demonstrated an extended cervico-thoracic medullar hyperintensity on the T2-weighted images. Cerebrospinal fluid (CSF) analysis showed 100 leukocytes/mm3, 0.94 g/L protein, negative VZV PCR, elevated rate of anti-VZV IgG and no oligoclonal bands. Clinical, biological and radiological presentations were compatible with the diagnosis of VZV-related myelitis with three potential pathophysiological mechanisms: infectious, immune post-infectious, vascular. The course was partially favorable after a 3-day regimen of corticosteroid and 3 weeks of acyclovir infusions.


CONCLUSIONS
Parainfectious myelitis is often the consequence of a viral infection with a post-infectious pathogenesis. Most often, the clinical outcome is good. In this case report, we highlight the VZV vascular tropism and its more severe outcome.


CONCLUSIONS
VZV-related myelitis should be diagnosed early. The combination of aciclovir and corticoids infusions seems to be beneficial.
Outteryck
O
O
Clinique Neurologique, Hôpital Roger Salengro, CHRU de Lille, 59037 Lille Cedex.
Deramecourt
V
V
Bombois
S
S
Mackowiak-Cordoliani
M A
MA
Pasquier
F
F
D006562:Herpes Zoster; D006801:Humans; D008297:Male; D008875:Middle Aged; D009187:Myelitis / Q000503:physiopathology* / Q000821:virology*