成人に発症した水痘再感染による水痘肺炎及び水痘 ―帯状疱疹ウイルス髄膜炎の1 例―

水痘再感染による水痘肺炎・VZV 髄膜炎の1 例

抄録

The patient was a 74-year old male who presented with a skin rash, cough, and impaired consciousness. Adiffuse, systemic, dark red rash was observed and he was admitted. Varicella infection was diagnosed based on the varicella-zoster virus (VZV)-IgM levels. The extremely high VZV- IgG levels observed were unlikely to be present inaninitial infection and the infection was thought to be a reoccurrence. Diffuse nodular shadows measuring ≤5mm indiameter were observed on chest computed tomography (CT) ; this was consistent with the typical imaging findings of varicella pneumonia.
The cerebrospinal fluid (CSF) was positive for CSF VZV-IgM antibody, CSF VZV-PCR, and CSF antibody titer index. A diagnosisofvaricella meningitis was made. When both respiratory and neurological symptoms are observed inpatients with varicella infection, it is necessary to consider a combined diagnosis of varicella pneumonia and varicella meningitis/encephalitis and perform chest imaging and a CSF examination. Repeated asymptomaticre-infection isconsidered necessary in order to maintaina life long immunity to varicella ; however, the opportunities for asymptomaticre-infection are decreasing with the declining birth rate and trend toward small families. As a result, reoccurrences of varicella infection in the elderly are expected to increase with rapidlyincreasing longevity.