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Varicella Zoster Aseptic Meningitis: Report of an Atypical Case and Literature Review

Unusual clinical course, Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)

Walid Ibrahim, Abdel-Naser Elzouki, Ahmed Husain, Lubna Osman

Department of Internal Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

Am J Case Rep 2015; 16:594-597

DOI: 10.12659/AJCR.894045

Available online:

Published: 2015-09-04

BACKGROUND: Neurologic complications can occur with varicella zoster virus (VZV) infection, usually after vesicular exanthem. A review of the literature revealed 3 cases of viral meningitis associated with 6th nerve palsy but without significantly increased intracranial pressure.
CASE REPORT: We report a case of a previously healthy 15-year-old girl with aseptic meningitis as a result of reactivated-VZV infection with symptoms of increased intracranial pressure and reversible 6th cranial nerve palsy but without exanthema.
Diagnosis was made by detection of VZV-DNA in cerebrospinal fluid using polymerase chain reaction and documented high intracranial pressure. Full recovery was achieved after a course of acyclovir and acetazolamide.
CONCLUSIONS: This case demonstrates that VZV may be considered in cases of aseptic meningitis in immunocompetent individuals, even without exanthema, and it may increase the intracranial pressure, leading to symptoms, and causing reversible neurological deficit.

Keywords: Female, Antiviral Agents - therapeutic use, Adolescent, Herpes Zoster - drug therapy, Herpesvirus 3, Human, Humans, Meningitis, Aseptic - drug therapy, Meningitis, Viral - drug therapy