Varicella zoster virus cerebellitis in a 66-year-old patient without herpes zoster

VZV-mediated herpes zoster, a cutaneous vesicular erythematous rash in the affected dermatomes, and chickenpox can both lead to complications involving the CNS and can cause myelitis, encephalitis, meningitis, and cranial-nerve palsies.1 In children, acute cerebellitis after chickenpox infection is...

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Bibliographic Details
Published in:The Lancet (British edition) 2006-01, Vol.367 (9505), p.182-182
Main Authors: Ratzka, Peter, Schlachetzki, Johannes CM, Bähr, Mathias, Nau, Roland
Format: Article
Language:English
Subjects:
Aged
Antibodies, Viral - isolation & purification
Biological and medical sciences
Case studies
Dermatitis
Gait Ataxia - virology
General aspects
Herpes viruses
Herpesvirus 3, Human - immunology
Herpesvirus 3, Human - pathogenicity
Human viral diseases
Humans
Infectious diseases
Male
Medical sciences
Viral diseases
Viral diseases with cutaneous or mucosal lesions and viral diseases of the eye
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Summary:VZV-mediated herpes zoster, a cutaneous vesicular erythematous rash in the affected dermatomes, and chickenpox can both lead to complications involving the CNS and can cause myelitis, encephalitis, meningitis, and cranial-nerve palsies.1 In children, acute cerebellitis after chickenpox infection is quite frequent.2 VZV infections with neurological symptoms but without cutaneous lesions are rarely diagnosed. Specifically, cases of VZV-mediated polyneuritis cranialis,3 vasculitis,4 and meningoencephalitis5 without cutaneous manifestation have been reported. Involvement of the CNS by VZV infection or reactivation is indicated by a high CSF leucocyte count. Frequently, CNS complications can be diagnosed early in the course of the disease by positive VZV PCR of the CSF. By contrast, a normal serological VZV antibody titre and CSF/serum VZV antibody ratio at onset of the disease do not exclude VZV-associated CNS involvement. The CSF/ serum VZV antibody ratio usually increases 1-2 weeks after clinical manifestation of the disease and indicates the production of VZV antibodies within the CNS. As in our case, the CSF/serum VZV antibody ratio can continue to increase during recovery, because antibody titres decrease less rapidly in the CSF than in the serum. In our case, owing to the absence of a typical rash, VZV-PCR analysis of the CNS was delayed, and subsequently diagnosis and treatment were retarded.
ISSN:0140-6736
1474-547X
DOI:10.1016/S0140-6736(06)67967-1