Varicella zoster virus meningo-encephalo-myelitis in an immunocompetent patient.
OBJECTIVE
To describe clinical, MRI and cerebrospinal fluid (CSF) features of a varicella zoster virus (VZV) related meningo-encephalo-myelitis (MEM) without rash in an immunocompetent female.


METHODS
An 85 year old immunocompetent woman with mild hyperthermia and acute, severe MEM.


METHODS
Serum antibodies and CSF PCR were searched for several viruses. Brain and spinal cord MRI were performed. Immunological profile.


METHODS
i.v. acyclovir 30 mg/kg/day; i.v. 6-MP 125 mg/day.


RESULTS
Marked CSF lymphomonocytic pleocytosis, blood-brainbarrier damage, and PCR detection of 3.05 X 10 6 copies of VZV DNA. MRI revealed lesions of the meninges, brain and spinal cord. No evidence of immunosuppression.


CONCLUSIONS
We highlight the importance of considering the possibility of VZV related MEM, even in immunocompetent patients. We also provide a MRI description of VZV related multifocal myelitis, not previously available. As supported by other reports, we underline the necessity of a prompt therapeutic intervention in this life-threatening condition.
Tavazzi
Eleonora
E
Department of Clinical Neurology, C. Mondino IRCCS Foundation, Pavia, Italy.
Minoli
Lorenzo
L
Ferrante
Pasquale
P
Scagnelli
Paola
P
Del Bue
Serena
S
Romani
Alfredo
A
Ravaglia
Sabrina
S
Marchioni
Enrico
E
D000212:Acyclovir / Q000627:therapeutic use; D000369:Aged, 80 and over; D000998:Antiviral Agents / Q000627:therapeutic use; D001812:Blood-Brain Barrier / Q000276:immunology / Q000473:pathology / Q000821:virology; D001921:Brain / Q000276:immunology / Q000473:pathology / Q000821:virology; D002555:Cerebrospinal Fluid / Q000166:cytology; D042241:Early Diagnosis; D020804:Encephalitis, Varicella Zoster / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008587:Meningitis, Viral / Q000276:immunology / Q000503:physiopathology* / Q000821:virology; D013116:Spinal Cord / Q000276:immunology / Q000473:pathology / Q000821:virology; D016896:Treatment Outcome
D000998:Antiviral Agents; D000212:Acyclovir