An Adult Case of Varicella with Polyneuropathy

Abstract

Varicella is an acute infectious disease caused by the varicella-zoster virus. Most people are infected in childhood, before 10 years of age. However, a recent survey reported that the age of onset of varicella has shifted from young children to older children and adults. Varicella developing in adults tends to be more severe than that in children, and infection in patients with immunodeficiency due to medical treatments such as corticosteroids and chemotherapy is often fatal. Herein, we report an adult case of varicella with polyneuropathy.

The complication that was most associated with the QOL in this patient was dysphagia. Glossopharyngeal nerve paralysis impaired pharyngeal perception, hypoglossal nerve paralysis impaired passage of a food bolus into the pharynx, and vagus nerve paralysis caused glottic insufficiency and diminished pharyngeal muscle contraction, in addition to weakening the laryngeal sphincter function. It is considered that such patients are at a higher risk of dysphagia and aspiration because of impairment of the laryngeal reflex caused by sensory deficiency of the larynx. Due to the impaired swallowing function, the patient developed aspiration pneumonia while hospitalized, despite receiving direct swallowing training. Among the patients with cranial nerve palsies, it has been reported that vagus nerve disorder is associated with a poorer prognosis than disorder of other nerves. Varicella is not commonly associated with multiple cranial nerve palsies, but when cranial neuropathy does occur as a complication, it could significantly reduce a patient’s QOL; therefore, it is necessary to closely monitor adult patients developing varicella.