Dear colleagues,
the case is a 16-year old boy who was diagnosed with Herpes Zoster Encephalitis. He developed headaches, had to stay home, had temperatures around 37,3 celsius, showed the zoster rash on day 3 (when brivudin and ibuprofene were started), then started vomiting frequently without gastroenteritic symptoms, and was hospitalized on day 4 when meningeal affection was found.
He had no neurologic deficit, was treated on ICU for 3 days with aciclovir and antibiotics, liquor showed a mild increase in cell count (260) and doubled proteines.
PCR found a count of 36000 varizella zoster virus copies. Since there was no trace of bacteria in the liquor culture antibiotics were suspended.
The treating colleagues (the patient is a family member and the field not so familiar to me) were puzzeled to find this rare diagnosis in a healthy 80kg boy who had varicella immunization in 2000.
MRT is planned for next week. Immune status will be checked the next days. The iv antiviral therapy will be continued for 10 more days.
the clinical course is very promising (only very mild headache once today) so the exspectation is that recovery will be soon and complete.
Since the case seems to be quite extraordinary I am very interested in your personal experience.
THANK YOU
I usually treat with forscarnet plus IVIG or preferably enriched immunoglobulin is available.
Few refractory cases have used cidofovir when not responsive to forscarnet, especially in high risk allogeneic transplant recipients
Dear colleagues,
the boy has been responding well clinically to aciclovir iv treatment. So far the immune status seems to be normal. Two days of recurring headaches have irritated us but we hope the clinical course will continue favorably without any residual pain syndromes.
Amar Safdar, do you use the immunoglubulin therapy in immunocompetent patients also?
Thank you very much for your time and help!
Yours sincerely
Ulrike Lewan
It has been estimated that 0.01% to 0.25% of patients with varicella (Chiken Box, Herpes Zoster and Varicilla syndrome which is compination of both of them) develop overt neurological complications such as cerebellar ataxia, encephalitis, transverse myelitis, aseptic meningitis, polyneuritis, cranial neuropathies, and Reye syndrome. Neurological sequelae are more common in the herpes zoster phase. These sequelae include-in order of decreasing incidence-postherpetic neuralgia, cranial nerve palsies, peripheral motor neuropathy, myelitis, encephalitis, thrombotic cerebral vasculopathy, acute ascending polyradiculitis, and aseptic meningitis.
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