Varicella Zoster viral encephalitis without herpes: diagnosis by metagenomic next-generation sequencing of cerebrospinal fluid

• Published in: Future microbiology 2023-11, Vol.18 (17), p.1217-1223
• Main Authors: Hong, Xin, Ji, Youqi, Chen, Mengyuan, Su, Fang, Zhu, Yongze, Ge, Yumei
• Format: Article
• Language: English
• Subjects: Antiviral Agents - therapeutic use; central nervous system; cerebrospinal fluid; Chickenpox - drug therapy; encephalitis; Encephalitis, Varicella Zoster - diagnosis; Encephalitis, Varicella Zoster - drug therapy; Female; Herpes Zoster - diagnosis; Herpes Zoster - drug therapy; High-Throughput Nucleotide Sequencing; Humans; metagenomic next-generation sequencing; Varicella Zoster virus; Young Adult
• ISSN: 1746-0913; 1746-0921
• DOI: 10.2217/fmb-2023-0107

Acute Varicella Zoster viral encephalitis in immunocompetent adult patients without cutaneous herpes has rarely been reported. A 24-year-old female was hospitalized for a headache with a fever but without other obvious symptoms. Multiple routine examinations showed no abnormalities. Lumbar puncture indicated intracranial hypertension. The examination of cerebrospinal fluid by metagenomic next-generation sequencing demonstrated acute Varicella Zoster viral encephalitis. The patient’s condition improved by treatment with acyclovir for antiviral therapy and mannitol dehydration to lower cranial pressure. Central Varicella Zoster viral infection should be emphasized as it is easily misdiagnosed and rare in clinical settings. Metagenomic next-generation sequencing of cerebrospinal fluid has significant advantages in the diagnosis of Varicella Zoster viral encephalitis.