A Case of VZV Reactivation Resulting in Aseptic Meningitis and Multiple Cranial Neuropathy

Abstract

Reactivation of varicella-zoster virus (VZV) can cause a wide variety of neurological syndromes. We report the case of a 65-year-old man with aseptic meningitis and multiple cranial neuropathies developing as a result of VZV reactivation.

The diagnosis of aseptic meningitis due to VZV reactivation was made based on an elevated value of the V-Index. Although the patient was initiated on treatment with aciclovir and a steroid, palsy of cranial nerves IX and X was found to still persist at 2 months after discharge.

In patients presenting with lower cranial nerve neuropathy, the ideal approach is to exclude central nervous system disease, head and neck tumors, and prior surgery, then submit a blood specimen for determination of the serum VZV antibody titers, and then carefully observe the patient for appearance of a skin rash or of enanthema by daily laryngoscopy to obtain an early diagnosis and ensure start of antiviral drug and high-dose steroid therapy at an early stage of the disease.