Severe Primary Varicella-Zoster Virus Meningitis With Dual Cranial Neuropathy (Cranial Nerve VII and Cranial Nerve XII) in a 67-Year-Old Man With Post-traumatic Asplenia: A Case Report

Primary varicella-zoster virus (VZV) infection in adults can cause severe systemic and neuroinvasive complications, particularly in older patients and those with impaired splenic function.A 67-year-old man with post-traumatic asplenia and hypertension presented on day five of varicella with acute viral meningitis, right peripheral facial nerve palsy (cranial nerve (CN) VII), and right hypoglossal nerve palsy (CN XII).Cerebrospinal fluid (CSF) analysis, including multiplex polymerase chain reaction (PCR) testing, confirmed VZV infection with lymphocytic pleocytosis and elevated protein levels.Contrast-enhanced magnetic resonance imaging of the brain revealed localized leptomeningeal enhancement without brainstem or parenchymal involvement.Following diagnosis, an appropriate course of intravenous and oral antiviral therapy was administered, resulting in a marked clinical and laboratory response.Oral pregabalin was initiated and titrated for persistent subacute neuropathic pain.Meningitis and systemic infection resolved, and the patient was discharged in stable condition with outpatient follow-up for CN recovery and neuralgia management.This case highlights the risk of severe neuroinvasive VZV in older asplenic patients and supports early CSF PCR testing and prompt initiation of extended antiviral therapy in high-risk individuals.