Acute varicella-zoster virus necrotizing meningoencephalomyelitis with sudden visual loss and paraparesis in an HIV-infected patient.
We describe a case of acute varicella-zoster virus (VZV) hemorrhagic meningoencephalomyelitis in an HIV-infected patient. On admission the patient's CSF was mild haemorrhagic and xanthochromic after centrifugation and he had thoracic skin blisters. VZV DNA was isolated from both the thoracic blisters and CSF. Treatment consisted of aggressive antiviral, steroid and immunoglobulin therapy, which was able to stop disease progression. The patient survived but was left blind and paretic. In conclusion, a diagnosis of CNS infection caused by VZV, based upon CSF analysis and examination of the skin for typical blisters, requires aggressive empiric antiviral therapy in order to maximise patient survival.
Tascini
Carlo
C
UO. Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy. c.tascini@ao-pisa.toscana.it
Polidori
Marina
M
Flammini
Sarah
S
Fondelli
Serena
S
Mencarini
Jessica
J
Vetrano
Umberto
U
Lambelet
Paola
P
Tagliaferri
Enrico
E
Menichetti
Francesco
F
D001766:Blindness / Q000209:etiology*; D002490:Central Nervous System / Q000821:virology; D004679:Encephalomyelitis / Q000209:etiology*; D015658:HIV Infections / Q000150:complications* / Q000821:virology; D006562:Herpes Zoster / Q000150:complications* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D020335:Paraparesis / Q000209:etiology*