Open AccessVaricella-zoster meningitis in an immunocompetent young man presenting with a painless erythematous rash
Author(s) -
Sahand Imani,
Natalie C Palavra,
Carly Oboudiyat,
Jerome Ip
Publication year - 2020
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-233511
Subject(s) - medicine , rash , meningitis , pleocytosis , lumbar puncture , lymphocytic pleocytosis , varicella zoster virus , dermatology , viral meningitis , surgery , past medical history , cerebrospinal fluid , pediatrics , virus , immunology , encephalitis , bacterial meningitis
A 32-year-old man presented with a 7-day history of generalised headache, intermittent fever, emesis and diarrhoea. Four days after symptom onset, he developed a vesicular rash on his medial left thigh, without associated pain, paraesthesia or pruritus. He had no significant past medical history, and no HIV risk factors. He was presumed to have enteroviral meningitis and was commenced on supportive therapy. Lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed a lymphocytic pleocytosis. While awaiting CSF serology, the formation of a new vesicle was noted at the site of the rash and was swabbed. Results for both the CSF and vesicle swab returned positive for varicella-zoster virus (VZV) confirming concurrent VZV meningitis with atypical painless herpes zoster in a young immunocompetent patient. He was initiated on intravenous acyclovir and made a full recovery after 2 weeks of treatment.