Neurological manifestations of Varicella zoster infection: A case series

Abstract

Introduction: Varicella zoster virus (VZV) causes infection of the central nervous system, which manifests as various neurological syndromes. In this case series, we discuss three different clinical presentations of VZV reactivation (herpes zoster). The main clinical feature of herpes zoster is a pruritic vesicular rash, present in a dermatomal distribution, which occurs after reactivation of the virus because of immunosuppression.Patients presentation: We report on three individual cases of complicated herpes zoster that resulted in various neurological pathologies. The patients described in this case series each received a lumbar puncture with cerebrospinal fluid analysis, which showed a positive varicella zoster polymerase chain reaction test (VZV PCR).Management and outcome: All three patients received intravenous acyclovir as their core component of treatment. In addition to this, some received other adjunctive treatments, mainly corticosteroids. Two patients achieved disease resolution while one patient demised.Conclusion: The case series highlights the various ways in which VZV can affect the central nervous system (CNS) such as meningitis, encephalitis, myelitis and arteritis.Contribution: This is a brief overview of the clinical manifestations of VZV affecting the CNS in patients presenting to a regional hospital within the Western Cape province in South Africa.