Varicella-zoster virus transverse myelitis in the absence of skin lesions

Authors

  • Adriana Calil Bernardes Instituto de Infectologia Emílio Ribas - São Paulo - São Paulo - Brasil
  • Claudia Figueiredo Mello Instituto de Infectologia Emílio Ribas - São Paulo - São Paulo - Brasil

DOI:

https://doi.org/10.5935/2764-734X.e20231231

Keywords:

Varicella zoster virus infection, Myelitis, Transverse, Zoster sine herpete, Case report

Abstract

Varicella-zoster virus (VZV) myelitis is a rare complication in individuals without immune dysfunction, but relatively frequent in immunocompromised individuals. Neurological changes can be serious and lead to death or sequelae, especially if there is a delay in starting the treatment. We report the clinical case of a human immunodeficiency virus-infected trans woman complaining of urinary retention, paresis, and paresthesia of the lower limbs 10 days after the appearance of allodynia in a thoracic dermatome affected by herpes zoster in the past. There were no skin lesions at all, such as the vesicles and blisters typical of VZV reactivation, and all the complementary tests were unable to establish an unequivocal etiological diagnosis. Even so, empirical treatment with high-dose intravenous acyclovir for 14 days exhibited a satisfactory clinical response, with immediate partial reversal of the neurological deficits.

Downloads

Download data is not yet available.

References

1. Moshayedi P, Thomas D, Rinaldo CR, Moossy JJ, Maroon JC, Murdoch GH, et al. Subacute histopathological features in a case of varicella zoster virus myelitis and post-herpetic neuralgia. Spinal Cord Ser Cases. 2018 Apr;4(1):33. DOI: 10.1038/s41394-018-0068-5

2. Lameiras C, Patrocínio de Jesus R, Flor-de-Lima B, Silva J, Pacheco P. A case of varicella-zoster virus meningomyelitis in an HIV-1-infected patient: facing the challenges related to its management and prognosis. Cureus. 2022 Aug;14(8):e27652. DOI: 10.7759/cureus.27652

3. Liu Q, Zhou X, Li Z. Acute myelitis with multicranial neuritis caused by varicella zoster virus: a case report. BMC Neurol. 2022;22(1):45. DOI: 10.1186/s12883-022-02571-y

4. Yun D, Cho SY, Ju W, Seo EH. Transverse myelitis after infection with varicella zoster virus in patient with normal immunity: a case report. World J Clin Cases. 2021 Nov;9(33):10308-14. DOI: 10.12998/wjcc.v9.i33.10308

5. Cree BAC. Acute inflammatory myelopathies. Handb Clin Neurol. 2014;122:613-67. DOI: 10.1016/B978-0-444-52001-2.00027-3

6. Simone CG, Emmady PD. Transverse Myelitis. [Updated 2022 Nov 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Disponível em: https://www.ncbi.nlm.nih.gov/books/NBK559302/

7. West TW. Transverse myelitis - a review of the presentation, diagnosis, and initial management. Discov Med. 2013;16(88):167-77. Disponível em: https://pubmed.ncbi.nlm.nih.gov/24099672/

8. Miyake Z, Tomidokoro Y, Nohara S, Tamaoka A. Chronic myelitis associated with zoster sine herpete. A case report. Medicine. 2019 Aug;98(32):e16671. DOI: 0.1097/MD.0000000000016671

9. Blanchardiere AD, Rozenberg F, Caumes E, O Picard, F Lionnet, J Livartowski, et al. Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection. Scand J Dis. 2000;32(3):263-9. DOI: 10.1080/00365540050165893

10. Zhou J, Li J, Ma L, Cao S. Zoster sine herpete: a review. Korean J Pain. 2020 Jul;33(3):208-15. DOI: 10.3344/kjp.2020.33.3.208

11. Takahashi T, Tamura M, Miki K, Yamaguchi M, Kanno A, Nunomura S, et al. Varicella zoster virus myelitis in two elderly patients: diagnostic value of nested polymerase chain reaction assay and antibody index for cerebrospinal fluid specimens. Case Rep Neurol. 2013 Apr;5(1):81-90. DOI: 10.1159/000350714

Downloads

Published

2023-02-27

How to Cite

1.
Bernardes AC, Mello CF. Varicella-zoster virus transverse myelitis in the absence of skin lesions. IeE [Internet]. 2023 Feb. 27 [cited 2026 May 1];2:e20231231. Available from: https://infectionsinevidence.org/index.php/journal/article/view/25

Issue

Vol. 2 (2023)

Section

Case Reports

License

Copyright (c) 2023 Infections in Evidence

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

All users may freely read, download, share, and adapt this scientific product for any purpose (even commercial ones), provided that due credit is given to the authors and the original publication, and that any alterations are duly indicated.

 

 

> Ethics

All articles published herein have received ethical approval from the National Research Ethics System (formerly CEP/CONEP system) based on Federal Law 14.874/24 and other specific Brazilian regulations, or a similar document attesting to the knowledge and authorization from the institution of origin in the case of foreign works.

The authors declare that there is no sponsorship or conflict of interest of any kind, unless otherwise indicated in the body of the article.

It is worth noting that case reports are a valuable learning resource for the scientific community, but should not be used in isolation to guide diagnostic or therapeutic options in clinical practice or health policies