title: Varicella-zoster meningitis with a late-onset of skin eruption.
abstract: Viral meningitis caused by varicella-zoster virus (VZV) is an uncommon neurological complication of herpes zoster. It may occur before or after the onset of the vesicular rash along the dermatomal distribution, which is the classic presentation of herpes zoster. We describe a case of a 51-year-old immunocompetent Caucasian man who presented with neck and severe right-sided facial pain. Eight days later, he had photophobia and papular rash on his forehead. Cerebrospinal fluid (CSF) examination confirmed aseptic meningitis and CSF PCR detected the presence of VZV DNA. Neurological complications of VZV infection, such as aseptic meningitis, may be difficult to diagnose and can cause delay in treatment, especially in cases with late onset of dermatological manifestations of herpes zoster. Definite diagnosis requires evidence of acute VZV infection in blood or cerebrospinal fluid.
authors.affiliation: Bassett Medical Center, Columbia University College of Physicians and Surgeons, Cooperstown, New York, USA Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Anawin
authors.identifier: http://orcid.org/0000-0002-3662-4136
authors.initials: A
authors.lastname: Sanguankeo
authors.affiliation: Bassett Medical Center, Columbia University College of Physicians and Surgeons, Cooperstown, New York, USA Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: Sikarin
authors.initials: S
authors.lastname: Upala
authors.affiliation: Bassett Medical Center, Columbia University College of Physicians and Surgeons, Cooperstown, New York, USA.
authors.forename: Suthanya
authors.initials: S
authors.lastname: Sornprom
authors.affiliation: Bassett Medical Center, Columbia University College of Physicians and Surgeons, Cooperstown, New York, USA.
authors.forename: Natanong
authors.initials: N
authors.lastname: Thamcharoen
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D005076:Exanthema / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D006562:Herpes Zoster / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D006801:Humans; D008297:Male; D008587:Meningitis, Viral / Q000134:cerebrospinal fluid / Q000209:etiology*; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D000998:Antiviral Agents; D014633:Valine; D000077483:Valacyclovir; D000212:Acyclovir