EXPECT THE UNEXPECTED: A CASE OF VZV-INDUCED HYDRCEPALUS IN A PATIENT WITH RECURRENCE OF CLL

Abstract

TYPE: Abstract TOPIC: Critical Care INTRODUCTION: Varicella-Zoster virus followed by herpes virus is the 2 most common viral causes of acute Encephalitis/Meningitis, especially in immunocompromised patients. Reactivation of VZV, after the primary chickenpox, generally presents as vesicular rash in one or more dermatomes, preceding or following the main manifestation. Neurological symptoms by VZV are well documented in the elderly, but it is rare to cause hydrocephalus. CASE PRESENTATION: A case of a 70-year-old male with a past medical history of Chronic Lymphocytic Leukemia about 23 years ago presented to the emergency department due to persistent nausea, vomiting, diarrhea, headache, and weakness for 5 days. After the first laboratory examination, a diagnosis of recurrence of CLL was made. He became increasingly lethargic and was started on Ceftriaxone, Azithromycin, and Acyclovir for suspicion of encephalitis. CSF PCR panel was positive for VZV and rhinovirus, negative for bands. He was intubated for airway protection. He underwent leukapheresis twice to reduce leukostasis. On Day 3 of the ICU stay, he remained obtunded, CT head revealed developing hydrocephalus, an external ventricular drain was placed. Repeat CSF revealed persistent positive VZV virus. Over the next few days, he remained comatose with no movements or improvement in neurological status and eventually passed away. DISCUSSION: Immunocompromised patients who have impaired T-cell mediated immunity are prone to viral encephalitis. This is the first reported case of VZV-induced hydrocephalus. CONCLUSIONS: It is important to raise awareness of the risk of VZV reactivation with severe neurological complications in patients with reactivation of malignancy. Acyclovir should be initiated early to prevent complications. DISCLOSURE: Nothing to declare. KEYWORD: VZV