Case Report: Herpes zoster ophthalmicus progressing to encephalitis: beware pain preceding the rash

He had a pulse of 112 beats per minute, blood pressure of 120/70mmHg, and a respiratory rate of 16 breaths per minute. Characteristic MR features may suggest the diagnosis of varicella zoster encephalitis, enabling definitive diagnostic testing and early institution of antiviral treatment. VSV encephalitis was diagnosed based on CSF pleocytosis, high serum and CSF titers of VZV antibody and EEG abnormality. VZV was identified in 16 of 20 cases by PCR detection of the DNA in the cerebrospinal fluid. It highlights a serious complication of this condition and is an important reminder that HZO should be considered among the differentials for severe unilateral headache in the elderly. The distal extremities are usually involved to a lesser extent. Acute disseminated encephalomyelitis (ADEM) and its more severe form, acute haemorrhagic leucoencephalitis (AHLE) represent non-infective central nervous system inflammatory diseases.

Case presentation: A 40-year-old Indian man presented with an acute history of four episodes of seizures, fever, headache, drowsiness, focal neurological deficits and vesicular eruptions over the abdomen in a typical dermatomal distribution. In addition, the patient had strong evidence of systemic lupus erythematosus, with a history of Raynaud’s phenomenon, migratory arthralgia, and unexplained anemia before the first attack of zoster with subsequent development of a positive lupus cell preparation and elevated antinuclear antibody levels. He had a history of chicken pox, and he had not received the herpes zoster (shingles) vaccine. VZV vasculopathy can cause ischaemic infarction of the brain and spinal cord, as well as aneurysm, subarachnoid and cerebral haemorrhage, carotid dissection, and, rarely, peripheral arterial disease. This 71-year-old woman presented to us approximately 1 year following resolution of a rapid-onset episode of HZE, and subsequently underwent neuropsychological and neuroimaging examinations. La Crosse encephalitis nearly always infects children (not infants or adults). We present an elderly woman with disseminated herpes zoster and altered mental status who was subsequently diagnosed with varicella zoster virus encephalitis and describe the characteristics of patients with disseminated zoster who developed varicella zoster virus encephalitis.

Twenty six of the patients were men, 19 women. Of these, three had involvement of the trigeminal nerve branch, one including an ophthalmic affection, and one presented with disseminated HZ. This may not be the complete list of references from this article. It highlights a serious complication of this condition and is an important reminder that HZO should be considered among the differentials for severe unilateral headache in the elderly. Hypoperfusion shown by single photon emission computed tomography, mostly involving the frontal areas bilaterally, was seen in six of the seven patients examined. Common All year VZV (herpesvirus) ds DNA Direct contact (air), highly contagious Variable; low in children Rash, encephalitis in 0.1-0.2% of children with chickenpox; cerebellar ataxia (cerebellitis) Adults worse; cerebellitis good Late winter, spring Influenza virus (orthomyxovirus) ss RNA Direct contact (air), highly contagious Unknown Reversible frontal syndrome in children; Guillain-Barré, myelitis Parkinsonism (encephalitis lethargica) Usually winter Enteroviruses (picornavirus) ss RNA Fecal-oral route Low; high for enterovirus 71 Herpangina; hand, foot, mouth disease; enterovirus 71 causes rhombencephalitis Mild, except for enterovirus 71 Summer, fall; tropics: no season Rabies virus (rhabdovirus) ss RNA Dogs, wild animals (eg, fox, wolf, skunk) Virtually 100% Paresthesias; confusion, spasms, hydrophobia; brainstem features Mortality virtually 100% All year ds—double strand; HSV—herpes simplex virus; ss—single strand; VZV—varicella-zoster virus. MRI revealed no pituitary abnormalities but encephalitis, and lumbar punction confirmed herpes zoster infection.

Patients usually present with clinical features of aseptic meningitis and/or encephalitis of varying degrees of severity. Their intrathecally synthesised HSV IgG was restricted to IgG1. Fourteen patients experienced postinfluenzal encephalopathy ⩽3 weeks after resolution of acute respiratory symptoms. If you continue browsing the site, you agree to the use of cookies on this website. On the other hand, it is well recognized that even severe chickenpox complications may occasionally occur in otherwise healthy people and especially subjects with unfavorable supporting conditions such as extreme old age, pregnancy, low-dose (including topical) corticosteroid therapy, and minor immunodeficient conditions. This article is designed to discuss general features of encephalitis; it is not designed to be all inclusive as book chapters have been written on individual causes. Uncertainty regarding the diagnosis occurs when patients with clinical features of ADEM occur in the background of viral infections or vaccine administration not significantly linked with the syndrome by epidemiological criteria.

She also had a concomitant herpes zoster rash on her back. In rare cases, encephalitis may follow vaccination against some of the viral diseases listed above. Lyme disease may also cause encephalitis. Preview of article PDF below. When compared to EEG in herpes zoster associated encephalitis, the findings were qualitatively the same, but tended to be more severe in the encephalitis cases. The site of focal herpes zoster encephalitis in the temporal lobe is marked with an arrow. Neither patient had skin eruptions usually associated with VZV reactivation, nor had either recently suffered from herpes zoster.

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