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, previously undiagnosed with 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.
Highlights
Varicella-Zoster Virus (VZV) is a highly infectious, exclusively human virus with worldwide prevalence
The reported cases of Froin's syndrome, in the context of a central nervous system (CNS) invasion by VZV, are mostly related to encephalitis, with only one case associated with myelitis
The fever, headache, and neck stiffness subsided, but sphincter function and lower limb paraplegia did not improve. This case report was about disseminating how atypical clinical symptoms of myelitis are in patients with Herpes Zoster (HZ) reactivation, in addition to the complications that these reactivations can have on a patient's lifestyle as a result of not improving after treatment
Summary
Varicella-Zoster Virus (VZV) is a highly infectious, exclusively human virus with worldwide prevalence.
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