Herpes zoster meningitis in immunocompetent children: Two case reports and a literature review

We encountered two cases of Herpes zoster ( HZ ) meningitis, a rarely occurring complication of HZ , in previously healthy children. One patient treated with i.v. acyclovir ( ACV , 31 mg/kg/day) did not recover. His symptoms were relieved somewhat by increased ACV dosage, but it caused transient renal dysfunction. Another patient treated with i.v. ACV (30 mg/kg/day) recovered. Treatment for HZ meningitis in immunocompetent children has not been established. In a literature review, 80% of 20 patients were treated with the usual dose of ACV 15–30 mg/kg/day. The present cases suggest that a high dosage of ACV up to 60 mg/kg/day should be considered (while monitoring for side‐effects) unless symptoms improve. In the review, one of every three vaccine‐strain Varicella zoster virus ( VZV ) cases was severe, whereas the present cases resulted from wild type. Further investigations must examine different clinical characteristics of HZ meningitis caused by wild‐type and vaccine‐strain VZV .