Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation
Meningitis caused by varicella zoster virus (VZV) is rare in healthy population. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. Here we report a young otherwise healthy man diagnosed with a VZV men...
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| Format: | Article |
| Language: | English |
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Wiley
2014-01-01
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| Series: | Case Reports in Neurological Medicine |
| Online Access: | http://dx.doi.org/10.1155/2014/686218 |
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| author | Thomas Pasedag Karin Weissenborn Ulrich Wurster Tina Ganzenmueller Martin Stangel Thomas Skripuletz |
| author_facet | Thomas Pasedag Karin Weissenborn Ulrich Wurster Tina Ganzenmueller Martin Stangel Thomas Skripuletz |
| author_sort | Thomas Pasedag |
| collection | DOAJ |
| description | Meningitis caused by varicella zoster virus (VZV) is rare in healthy population. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. Here we report a young otherwise healthy man diagnosed with a VZV meningitis without rash. He complained of acute headache, nausea, and vomiting. The clinical examination did not show any neurological deficits or rash. Cerebrospinal fluid (CSF) analysis revealed a high leukocyte cell count of 1720 cells/µL and an elevated total protein of 1460 mg/L misleadingly indicating a bacterial infection. Further CSF analyses, including polymerase chain reaction (PCR) and detection of intrathecal synthesis of antibodies, showed a VZV infection. Clinical and CSF follow-up examinations proved the successful antiviral treatment. In conclusion, even young immunocompetent patients without rash might present with VZV meningitis. CSF examination is a key procedure in the diagnosis of CNS infections but in rare cases the standard values cell count and total protein might misleadingly indicate a bacterial infection. Thus, virological analyses should be considered even when a bacterial infection is suspected. |
| format | Article |
| id | doaj-art-948861e8b0aa4779aa2fb80b1f1cb73e |
| institution | Kabale University |
| issn | 2090-6668 2090-6676 |
| language | English |
| publishDate | 2014-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Neurological Medicine |
| spelling | doaj-art-948861e8b0aa4779aa2fb80b1f1cb73e2025-02-03T01:02:38ZengWileyCase Reports in Neurological Medicine2090-66682090-66762014-01-01201410.1155/2014/686218686218Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical PresentationThomas Pasedag0Karin Weissenborn1Ulrich Wurster2Tina Ganzenmueller3Martin Stangel4Thomas Skripuletz5Department of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyDepartment of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyDepartment of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyInstitute of Virology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyDepartment of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyDepartment of Neurology, Hannover Medical School, Carl-Neuberg-Straße 1, 30625 Hannover, GermanyMeningitis caused by varicella zoster virus (VZV) is rare in healthy population. Predominantly immunocompromised patients are affected by reactivation of this virus with primary clinical features of rash and neurological symptoms. Here we report a young otherwise healthy man diagnosed with a VZV meningitis without rash. He complained of acute headache, nausea, and vomiting. The clinical examination did not show any neurological deficits or rash. Cerebrospinal fluid (CSF) analysis revealed a high leukocyte cell count of 1720 cells/µL and an elevated total protein of 1460 mg/L misleadingly indicating a bacterial infection. Further CSF analyses, including polymerase chain reaction (PCR) and detection of intrathecal synthesis of antibodies, showed a VZV infection. Clinical and CSF follow-up examinations proved the successful antiviral treatment. In conclusion, even young immunocompetent patients without rash might present with VZV meningitis. CSF examination is a key procedure in the diagnosis of CNS infections but in rare cases the standard values cell count and total protein might misleadingly indicate a bacterial infection. Thus, virological analyses should be considered even when a bacterial infection is suspected.http://dx.doi.org/10.1155/2014/686218 |
| spellingShingle | Thomas Pasedag Karin Weissenborn Ulrich Wurster Tina Ganzenmueller Martin Stangel Thomas Skripuletz Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation Case Reports in Neurological Medicine |
| title | Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation |
| title_full | Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation |
| title_fullStr | Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation |
| title_full_unstemmed | Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation |
| title_short | Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation |
| title_sort | varicella zoster virus meningitis in a young immunocompetent adult without rash a misleading clinical presentation |
| url | http://dx.doi.org/10.1155/2014/686218 |
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