title: Varicella zoster virus myelitis in two elderly patients: diagnostic value of nested polymerase chain reaction assay and antibody index for cerebrospinal fluid specimens.
abstract: BACKGROUND
  Myelitis is one of the rarest neurological complications of the varicella zoster virus (VZV) infection. Focal muscle weakness with or without sensory disturbance occurs in approximately 5% of the cases after acute VZV infection, with complete recovery in 50-70%.
  
  
  METHODS
  This report describes two rare cases of elderly patients with VZV myelitis secondary to dermatomal zoster rash. Patient 1 was a 79-year-old woman who developed paraplegia, numbness and decreased sensation in the left arm and below thoracic (Th)-10 after sacral zoster. Spinal cord MRI showed a high-signal-intensity lesion at the cervical spinal nerve 2 on a T2-weighted image. Patient 2 was a 73-year-old man who developed right flaccid leg weakness and urinary retention after right dorsal Th 5-8 zoster. Spinal cord MRI showed a high-signal-intensity lesion at Th 3-4 on a T2-weighted image. In both cases, although the conventional single polymerase chain reaction (PCR) assays all showed negative results, the original nested PCR assay detected VZV DNA in the cerebrospinal fluid (CSF) specimen collected on admission. In addition, the anti-VZV IgG antibody by enzyme immunoassay and antibody index were elevated in the CSF specimens during the clinical courses of both patients. On the basis of these findings, both patients were diagnosed with VZV myelitis and were treated with high-dose acyclovir and corticosteroid. This combined treatment was appropriate and effective for the improvement of their functional outcomes.
  
  
  CONCLUSIONS
  The detection of VZV DNA in CSF by nested PCR assay and the evaluation of the antibody index to VZV had significant diagnostic value.
authors.affiliation: Department of Neurology, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Teruyuki
authors.initials: T
authors.lastname: Takahashi
authors.forename: Masato
authors.initials: M
authors.lastname: Tamura
authors.forename: Kenji
authors.initials: K
authors.lastname: Miki
authors.forename: Mai
authors.initials: M
authors.lastname: Yamaguchi
authors.forename: Akira
authors.initials: A
authors.lastname: Kanno
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nunomura
authors.forename: Chisei
authors.initials: C
authors.lastname: Ra
authors.forename: Takashi
authors.initials: T
authors.lastname: Tamiya
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kamei
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takasu
keywords: Antibody index; Enzyme immunoassay; Myelitis; Nested polymerase chain reaction assay; Varicella zoster virus