title: Focal encephalitis following varicella-zoster virus reactivation without rash in a healthy immunized young adult.
abstract: Herein we describe an episode of focal varicella-zoster virus (VZV) encephalitis in a healthy young man with neither rash nor radicular pain. The symptoms began with headaches and seizures, after which magnetic resonance imaging detected a single hyperintense lesion in the left temporal lobe. Because of the provisional diagnosis of a brain tumor, the lesion was excised and submitted for pathological examination. No tumor was found. But the tissue immunostained positively for VZV antigens, and wild-type VZV sequences were detected. In short, this case represents VZV reactivation, most likely in the trigeminal ganglion, in the absence of clinical herpes zoster.
authors.affiliation: Department of Laboratory Medicine and Pathology.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Halling
authors.affiliation: Department of Laboratory Medicine and Pathology.
authors.forename: Caterina
authors.initials: C
authors.lastname: Giannini
authors.affiliation: Department of Neurology.
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Britton
authors.affiliation: Department of Neurology.
authors.forename: Ricky W
authors.initials: RW
authors.lastname: Lee
authors.affiliation: Department of Radiology.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Watson
authors.affiliation: Department of Internal Medicine.
authors.forename: Christine L
authors.initials: CL
authors.lastname: Terrell
authors.affiliation: Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ian F
authors.initials: IF
authors.lastname: Parney
authors.affiliation: Division of Infectious Diseases/Virology, University of Iowa Children's Hospital, Iowa City.
authors.forename: Erin M
authors.initials: EM
authors.lastname: Buckingham
authors.affiliation: Division of Infectious Diseases/Virology, University of Iowa Children's Hospital, Iowa City.
authors.forename: John E
authors.initials: JE
authors.lastname: Carpenter
authors.affiliation: Division of Infectious Diseases/Virology, University of Iowa Children's Hospital, Iowa City.
authors.forename: Charles
authors.initials: C
authors.lastname: Grose
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D004279:DNA, Viral / Q000235:genetics / Q000302:isolation & purification; D020804:Encephalitis, Varicella Zoster / Q000175:diagnosis* / Q000473:pathology* / Q000503:physiopathology; D005076:Exanthema / Q000473:pathology; D014645:Herpesvirus 3, Human / Q000276:immunology* / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D008279:Magnetic Resonance Imaging; D008297:Male; D010146:Pain / Q000503:physiopathology; D011859:Radiography; D012640:Seizures / Q000175:diagnosis / Q000209:etiology; D014775:Virus Activation; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: herpes zoster; latency; trigeminal ganglion; valacyclovir; varicella vaccine; varicella-zoster virus