Progressive multifocal leukoencephalopathy (PML)- immune reconstitution inflammatory syndrome (IRIS) evaluated using intrathecal IgG index: a case report

Abstract

We report an 80-year-old man with subarachnoid hemorrhage due to varicella-zoster virus（VZV）vasculopathy during antiviral therapy for VZV encephalopathy. The patient was transferred to our hospital because of fever and disturbance of consciousness. His cerebrospinal fluid（CSF）revealed monocyte dominant pleocytosis and elevated protein and was positive for VZV-DNA PCR, therefore intravenous acyclovir（ACV）was administered. On hospital day 8, he presented with headache, fever and deterioration of consciousness. His CSF showed xanthochromia and there was mild subarachnoid hemorrhage without any cerebral aneurysm on his head CT. He was diagnosed with VZV vasculopathy and added intravenous methylprednisolone therapy on ACV. He recovered and returned to work eight months after the onset. Based on previous studies, a better prognosis for VZV vasculopathy was inferred with the addition of prednisolone than with ACV monotherapy, therefore patients with VZV encephalitis need to be assessed for complications of VZV vasculopathy.