A Case of Multiple Cranial Nerve Palsy with Immune Reconstitution Inflammatory Syndrome Caused by Varicella Zoster Virus in a Patient with AIDS

Abstract

Varicella zoster virus (VZV) is known to cause immune reconstitution inflammatory syndrome (IRIS) in a high frequency in people infected with human immunodeficiency virus (HIV). However, severe cases of IRIS resulting in multiple cerebral nerve palsy are rare. We herein report on a case of an HIV-infected man who developed IRIS caused by VZV, presenting as multiple cranial nerve palsy involving cranial nerves V,VII, VIII, IX, X, and XII. The patient was a 40-year-old man who was diagnosed as having AIDS triggered by esophageal candidiasis 3 months previously. About 3 months after starting antiretroviral drug treatment,he was hospitalized with difficulty in swallowing, fever, and an exacerbated rash. His CD4 cell count was 42 cells/μL, and the HIV-RNA level was undetectable. The characteristic symptom of papules and scabs of different stages all over the body enabled us to quickly reach the correct diagnosis of VZV-IRIS. The patient was treated with acyclovir, corticosteroid pulses, and antiretroviral therapy. Although the patientʼs hypoglossal nerve palsy quickly improved, his swallowing difficulty required over 8 months to improve.