Varicella-zoster virus meningitis with hypoglycorrhachia in a young immunocompetent adult without rash: A case report and literature review

Overt aseptic meningitis rarely complicates varicella-zoster virus (VZV) reactivation in young and immunocompetent adults. Many of the cases of VZV meningitis are associated with an exanthem. We describe an otherwise healthy 36-year-old adult who had aseptic meningitis without skin rash, caused by reactivation of varicella-zoster virus. Cerebrospinal fluid (CSF) analysis revealed lymphocytosis, increased total protein, and low glucose. Diagnosis was made by polymerase chain reaction in CSF. The present case highlights the fact that VZV should be considered as a cause of aseptic meningitis with hypoglycorrhachia in healthy and young individuals, even in the absence of an exanthem.

• Publication year

  2018

• Venue

  IDCases

• Publication date

  2018-04-13

• Fields of study

  Medicine

• Identifiers
  DOI 10.1016/j.idcr.2018.04.008PMID 29682449PMCID 5909022
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Incidence of herpes zoster amongst adults varies by severity of immunosuppression.

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  2016cited by this paper
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• Incidence of herpes zoster and associated events including stroke—a population-based cohort study

  2015cited by this paper
• Zeroing in on zoster: A tale of many disorders produced by one virus.

  2015influential reference
• 88 – Approach to the Patient with Central Nervous System Infection

  2015cited by this paper
• Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation

  2014cited by this paper
• Viral infections of the central nervous system in Spain: A prospective study

  2013cited by this paper
• Infection of the central nervous system caused by varicella zoster virus reactivation: a retrospective case series study.

  2013cited by this paper
• Extreme hypoglycorrhachia: not always bacterial meningitis

  2010cited by this paper
• Neurological disease produced by varicella zoster virus reactivation without rash.

  2010cited by this paper
• Varicella zoster virus meningitis with hypoglycorrhachia in the absence of rash in an immunocompetent woman

  2009cited by this paper
• Humoral and cellular immunity to varicella-zoster virus: an overview.

  2008cited by this paper
• Clinical features of viral meningitis in adults: significant differences in cerebrospinal fluid findings among herpes simplex virus, varicella zoster virus, and enterovirus infections.

  2008cited by this paper
• The neurotropic herpes viruses: herpes simplex and varicella-zoster.

  2007influential reference
• Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases

  1995cited by this paper
• Varicella zoster-associated neurologic disease without skin lesions.

  1989cited by this paper

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