Acute cerebellar ataxia associated with varicella zoster virus encephalitis

Context: Varicella-zoster virus (VZV) primary infection causes a diffuse vesicular rash and affects mainly young people. VZV-associated encephalitis is a rare complication since the advent of vaccination, and can present as different neurological syndromes. This report aims to describe a case of acute cerebellar ataxia after VZV-associated encephalitis in a child, admitted to the Onofre Lopes University Hospital (HUOL) in Natal, Brazil. Case report: We present the case of a 9-year-old girl referred to HUOL with polymorphic skin lesions for 8 days. She evolved with headache, vomiting, drowsiness and confusion. Upon admission, she was pale (+/4+), anicteric, confused (GCS=14), hemodynamically stable, SaO2=99%, with pupillary response and no meningism. Laboratory tests showed Hb 11.7g/dl, leukocytes 7,200/mm³ (93% segmented, 1% eosinophils, 5% lymphocytes and 2% monocytes), AST 38U/ml and ALT 46U/ml. Once clinical diagnosis of VZVencephalitis was made, the patient was admitted to the ICU for monitoring and treatment. Cranial CT showed hypodensities on the frontal and occipital lobes; CSF analysis: glucose=76mg/dl, proteins=24mg/dl, leukocytes=9/mm3 (monocytes 78%). She improved progressively and was transferred to the ward, evolving with ataxia, suggesting cerebellitis. Conclusions: This case describes a chickenpox rare complication nowadays: encephalitis. Along evolution, the patient presented acute cerebellar ataxia, a more prevalent condition in children, usually having a limited course.