Varicella zoster virus infection presenting as isolated diplopia: a case report

Raffaella Pisapia,Andrea Mariano,Amina Abdeddaim,Alessandra Oliva,Simonetta Galgani,Laura Vincenzi,Alessia Rianda,Pasquale Narciso,Angela Testa

doi:10.1186/1471-2334-13-138

Abstract

BackgroundInvolvement of trochlear nerve during Varicella Zoster Virus (VZV) Infection has been rarely described, and always in association with skin rash.Case presentationWe describe the case of a patient with VZV infection presenting as isolated diplopia due to fourth cranial nerve palsy. The diagnosis has been obtained through the application of a standardized molecular diagnostic panel, and diplopia resolved after specific antiviral and corticosteroid therapy.ConclusionThis case evidences that clinicians should be aware of atypical VZV infection, even in the absence of the typical skin rash.

Highlights

Involvement of trochlear nerve during Varicella Zoster Virus (VZV) Infection has been rarely described, and always in association with skin rash
Neurological involvement includes a wide spectrum of diseases, from benign acute aseptic meningitis to severe manifestations, with meningitis and encephalitis, acute cerebellar ataxia, Guillain-Barré syndrome, Reye’s syndrome, myelitis, optic neuritis more frequently reported in case of primary varicella infection, and vasculopathy, focal motor weakness, Ramsay-Hunt syndrome, post-herpetic neuralgia and cranial nerves palsy more frequently reported in case of reactivation [1,2]
We describe the case of an adult patient, immunecompetent and without underlying diseases, with fourth nerve palsy, presenting diplopia as isolated symptom of central nervous system involvement during VZV infection without rash

Summary

Introduction

Involvement of trochlear nerve during Varicella Zoster Virus (VZV) Infection has been rarely described, and always in association with skin rash. Case presentation: We describe the case of a patient with VZV infection presenting as isolated diplopia due to fourth cranial nerve palsy. Varicella Zoster Virus (VZV) often causes central nervous system complications either during primary infection (chickenpox) and during reactivations. Neurological involvement includes a wide spectrum of diseases, from benign acute aseptic meningitis to severe manifestations, with meningitis and encephalitis, acute cerebellar ataxia, Guillain-Barré syndrome, Reye’s syndrome, myelitis, optic neuritis more frequently reported in case of primary varicella infection, and vasculopathy, focal motor weakness, Ramsay-Hunt syndrome, post-herpetic neuralgia and cranial nerves palsy more frequently reported in case of reactivation [1,2]. We describe the case of an adult patient, immunecompetent and without underlying diseases, with fourth nerve palsy, presenting diplopia as isolated symptom of central nervous system involvement during VZV infection without rash

Methods

Discussion

Conclusion