A Case Report of Acute Severe Myelitis and Meningitis Secondary to Varicella Zoster Virus Reactivation in a Patient with Acquired Immunodeficiency Syndrome

Authors

  • Victor A. Novelo-Hernández Universidad Autónoma de Nuevo León
  • Marco Cárdenas “University Hospital “José Eleuterio González”, Universidad Autónoma de Nuevo Leon, Monterrey. México.
  • Claudia Torres-González Universidad Autónoma de Nuevo León
  • Patricio Garcia-Espinosa Universidad Autónoma de Nuevo León https://orcid.org/0000-0002-8139-806X
  • Rómulo Ramirez “University Hospital “José Eleuterio González”, Universidad Autónoma de Nuevo Leon, Monterrey. México.
  • Marco Díaz-Torres “University Hospital “José Eleuterio González”, Universidad Autónoma de Nuevo Leon, Monterrey. México. https://orcid.org/0000-0002-6394-1604
  • Alejandro Marfil-Rivera Universidad Autónoma de Nuevo León https://orcid.org/0000-0002-8578-0338

DOI:

https://doi.org/10.5195/ijms.2021.863

Keywords:

Myelitis, HIV, Acquired Immunodeficiency Syndrome, Varicella Zoster Virus Infection

Abstract

Background: Myelitis post Herpes-Zoster is a rare condition that is typically associated with immunocompromised states. It usually starts as an acute loss of sensory and motor functions below the affected spinal cord level. The condition can range in severity from a mild to a fatal presentation. Other neurological complications include meningitis, atypical presentations should encourage the search for undiagnosed immunosuppression states.

The Case: We describe the case of a 42-year-old man, with previously undiagnosed HIV, who developed acute myelitis and meningitis after the appearance of the classic zoster lesions. On lumbar puncture and subsequent CSF analysis, the patient was found to have Froin's Syndrome. The patient was initiated with ceftriaxone, vancomycin, and acyclovir regimen and prophylactic antiphymic treatment was also added. After 14 days in the hospital, the fever, headache, and neck stiffness subsided while the sphincter function and lower limb paraplegia did not improve.

Conclusion: Varicella zoster virus reactivation suggests underlying immunosuppression. This case demonstrates the importance of being cognizant to the wide range of clinical manifestations that may suggest spinal cord involvement after clinical reactivation. Furthermore, physicians also need to be mindful that Acquired Immunodeficiency Syndrome (AIDS) and other immunodeficiency states could present with atypical clinical manifestations.

References

Pergam SA, Limaye AP. AST Infectious Diseases Community of Practice. Varicella zoster virus (VZV) in solid organ transplant recipients. Am J Transplant. 2009 Dec;9 Suppl 4(Suppl 4):S108-15.

Grabar S, Tattevin P, Selinger-Leneman H, de La Blanchardiere A, de Truchis P, Rabaud C, et al. Incidence of herpes zoster in HIV-infected adults in the combined antiretroviral therapy era: results from the FHDH-ANRS CO4 cohort. Clin Infect Dis. 2015 Apr 15;60(8):1269-77.

Chamizo FJ, Gilarranz R, Hernández M, Ramos D, Pena MJ. Central nervous system infections caused by varicella-zoster virus. J Neurovirol. 2016 Aug;22(4):529-32.

Gilden D, Nagel MA, Cohrs RJ, Mahalingam R. The variegate neurological manifestations of varicella zoster virus infection. Curr Neurol Neurosci Rep. 2013 Sep;13(9):374.

Corti M, Trione N, Villafañe MF, Risso D, Yampolsky C, Mamanna L. Acute meningoencephalomyelitis due to varicella-zoster virus in an AIDS patient: report of a case and review of the literature. Revista da Sociedade Brasileira de Medicina Tropical. 2011 Oct;44:784-6.

Agrawal MM, Mahajan RS, Bilimoria FE, Ninama KR. Myelitis: A Rare Neurological Complication of Herpes Zoster. Indian J Dermatol. 2016 Nov;61(6):687-9.

Nakano T, Awaki E, Araga S, Takai H, Inoue K, Takahashi K. Recurrent herpes zoster myelitis treated with human interferon alpha: A case report. Acta Neurol Scand. 1992 May;85:372–5.

Dancel R, Shaban M. IMAGES IN CLINICAL MEDICINE. Froin's Syndrome. N Engl J Med. 2016 Mar 17;374(11):1076.

Kleinschmidt-DeMasters BK, Mahalingam R, Shimek C, Marcoux HL, Wellish M, Tyler KL, Gilden DH. Profound cerebrospinal fluid pleocytosis and Froin's Syndrome secondary to widespread necrotizing vasculitis in an HIV-positive patient with varicella zoster virus encephalomyelitis. J Neurol Sci. 1998 Aug 14;159(2):213-8.

Kim SH, Choi SM, Kim BC, Choi KH, Nam TS, Kim JT, Lee SH, Park MS, Kim SJ. Risk Factors for Aseptic Meningitis in Herpes Zoster Patients. Ann Dermatol. 2017 Jun;29(3):283-287.

Hung CH, Chang KH, Kuo HC, Huang CC, Liao MF, Tsai YT, Ro LS. Features of varicella zoster virus myelitis and dependence on immune status. J Neurol Sci. 2012 Jul 15;318(1-2):19-24.

Kedar S, Jayagopal LN, Berger JR. Neurological and Ophthalmological Manifestations of Varicella Zoster Virus. J Neuroophthalmol. 2019 Jun;39(2):220-231.

Noaillon M, Breining A, Greffard S, Sagot C, Verny M. Post-Herpes zoster myelitis in a very old patient: A complication not to be missed. Geriatr Gerontol Int. 2016 Jan;16(1):145-6.

Garispe A, Naji H, Dong F, Arabian S, Neeki M. Froin's Syndrome Secondary to Traumatic and Infectious Etiology. Cureus. 2019 Dec 6;11(12):e6313.

Greenfield JG. Original Papers: ON FROIN'S SYNDROME, AND ITS RELATION TO ALLIED CONDITIONS IN THE CEREBROSPINAL FLUID. J Neurol Psychopathol. 1921 Aug;2(6):105-41.

Kennedy PG. Issues in the Treatment of Neurological Conditions Caused by Reactivation of Varicella Zoster Virus (VZV). Neurotherapeutics. 2016 Jul;13(3):509-13.

Abbas SA, El Helou J, Chalah MA, Hilal H, Saliba G, Abboud H, et al. Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual-A Rare Complication of Varicella-Zoster Virus Reactivation. Medicina (Kaunas). 2019 May 23;55(5):201.

Published

2021-08-12

How to Cite

Novelo-Hernández, V. A., Cárdenas, M., Torres-González, C., Garcia-Espinosa, P., Ramirez, R., Díaz-Torres, M. ., & Marfil-Rivera, A. (2021). A Case Report of Acute Severe Myelitis and Meningitis Secondary to Varicella Zoster Virus Reactivation in a Patient with Acquired Immunodeficiency Syndrome. International Journal of Medical Students, 9(3), 227–230. https://doi.org/10.5195/ijms.2021.863

Issue

Section

Case Report