Encephalitis is known as a rare complication of varicella zoster virus (VZV) reactivation. It is usually regarded as a complication of a cutaneous infection in patients with impaired cellular immunity. The reported incidence of herpetic motor involvement range between 0.5 and 31%, but is possibly more frequent as the weakness is readily obscured by pain. A 53-years-old woman, who presented with severe shoulder pain, fever, headache and seizure, which developed the day after skin eruptions, also developed motor paresis 7 days after the seizure. Her cerebrospinal fluid (CSF) was VZV-Polymerase chain reaction (PCR) negative, but VZV specific IgG antibody positive, and her brain MRI was found to be normal. With the early diagnosis and proper treatment, such as intravenous administration of acyclovir, stellate ganglion block and Yamamoto New Scalp Stimulation (YNSS), the patient completely recovered, without psychoneurological sequelae. Herein, we present this case, with a discussion of the relevant literature on the incidence, pathophysiology, diagnosis and management of central nervous system VZV involvement.
Acyclovir ; Administration, Intravenous ; Brain ; Central Nervous System ; Cerebrospinal Fluid ; Diagnosis ; Early Diagnosis ; Encephalitis* ; Female ; Fever ; Headache ; Herpes Zoster* ; Herpesvirus 3, Human ; Humans ; Immunity, Cellular ; Immunoglobulin G ; Incidence ; Magnetic Resonance Imaging ; Paresis* ; Scalp ; Seizures ; Shoulder Pain ; Skin ; Stellate Ganglion

Acute viral meningitis and myositis are rare complications of varicella-zoster virus (VZV) reactivation. A 71-years-old immunocompetent man, who presented with lower back pain radiating to the left lower extremities, developed vesicles on the L5 dermatomal area. The next day, he had complained of aberrant vesicles on the trunk, face and scalp, with generalized myalgia, headache and dizziness. He was confirmed with VZV meningitis and myositis, as demonstrated by the presence of VZV DNA in the blood and cerebral spinal fluid using a polymerase chain reaction (PCR) amplification. PCR has been used in patients with a VZV infection associated neurological symptoms, and provides a useful tool for the early diagnosis of VZV-associated neurological disease. The patient was treated with bed rest, with intravenous acyclovir for the VZV infection, and intravenous Patient-controlled Analgesia for pain management and the prevention of postherpetic neuralgia. When he visited the outpatient department 3 months later, the skin lesion, leg pain, headache and myalgia had all improved, without sequelae. Here, this case is reported, with a discussion of the relevant literature on its diagnosis and management.
Acyclovir ; Analgesia, Patient-Controlled ; Bed Rest ; Diagnosis ; Dizziness ; DNA* ; Early Diagnosis ; Headache ; Herpes Zoster* ; Herpesvirus 3, Human* ; Humans ; Leg ; Low Back Pain ; Lower Extremity ; Meningitis* ; Meningitis, Viral ; Myalgia ; Myositis ; Neuralgia, Postherpetic ; Outpatients ; Pain Management ; Polymerase Chain Reaction* ; Scalp ; Skin