title: Longitudinally extensive varicella-zoster virus myelitis in a patient with multiple sclerosis.
abstract: METHODS
  Case report.
  
  
  OBJECTIVE
  To report this rare varicella-zoster virus (VZV) complication in a patient with multiple sclerosis.
  
  
  BACKGROUND
  Longitudinally extensive transverse myelitis is a spinal cord lesion that extends over 3 or more vertebral segments. A common feature in neuromyelitis optica, longitudinally extensive transverse myelitis can also occur in several other diseases.
  
  
  METHODS
  A 15-year-old boy with relapsing-remitting multiple sclerosis, who has been treated with immunomodulators for 6 months, developed a subacute left brachiocrural hemiparesis with ipsilateral decreased sensation in the trunk and limbs. This was interpreted as a new relapse and was treated consequently. During the evolution, the patient developed a cutaneous rash in the left C8 metameres, followed by asymmetric tetraparesis.
  
  
  RESULTS
  Magnetic resonance imaging demonstrated an extensive cervical-thoracic myelopathy. Cerebrospinal fluid analysis revealed 17 leukocytes per microliter (95% mononuclear), protein 41 mg/dL, and negative VZV-DNA by polymerase chain reaction, but elevated anti-VZV immunoglobulin G cerebrospinal fluid/serum index, with a normal albumin cerebrospinal fluid/serum index, all of which were consistent with intrathecal synthesis of anti-VZV antibody. We were able to rule out all other causes included in the differential diagnosis, namely, vascular disease, tumor, and autoimmune conditions, especially those associated with neuromyelitis optica spectrum disorders.
  
  
  CONCLUSIONS
  Awareness of the potentially varied presentation of VZV myelitis can enable earlier recognition and specific treatment.
authors.affiliation: From the Departments of *Neurology; and †Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain; and ‡Serology Section, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain.
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Cuello
authors.forename: Julia
authors.initials: J
authors.lastname: Romero
authors.forename: Fernando
authors.initials: F
authors.lastname: de Ory
authors.forename: Clara
authors.initials: C
authors.lastname: de Andrés
mesh_terms: D000293:Adolescent; D000914:Antibodies, Viral / Q000276:immunology; D002574:Cervical Vertebrae / Q000821:virology; D003937:Diagnosis, Differential; D020804:Encephalitis, Varicella Zoster / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000276:immunology / Q000502:physiology; D054884:Host-Pathogen Interactions; D006801:Humans; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications*; D009187:Myelitis / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D013904:Thoracic Vertebrae / Q000821:virology
chemical_list: D000914:Antibodies, Viral