Abstract
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.
Highlights
Infections with neurotropic herpes viruses (herpes simplex type 1/2, varicella zoster virus (VZV)) are frequent in humans
We present a young previously healthy man with a VZV meningitis without rash. This case is extraordinary because the clinical presentation was unusual for a patient with meningitis and the initial Cerebrospinal fluid (CSF) findings with very high pleocytosis and elevated total CSF protein initially misleadingly suggested a bacterial infection
CSF examination is generally considered a key procedure in the diagnosis of central nervous system (CNS) infections [14]
Summary
Infections with neurotropic herpes viruses (herpes simplex type 1/2, varicella zoster virus (VZV)) are frequent in humans. These viruses persist within cranial nerves, dorsal roots, and autonomic ganglia causing latent infections with the ability of reactivation [1,2,3]. CNS infection with VZV comes along with dermal affection but can rarely develop without rash [1, 3, 5,6,7,8,9,10]. CNS infection with VZV in young healthy adults is rare and is unexpected and only very few cases have been described so far [5,6,7,8,9]. We describe a young previously healthy man with VZV meningitis who had only minimal symptoms
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
