Case reports in infectious diseases
Varicella Zoster Virus-Associated Meningoradiculitis in an Elderly Patient: A Case Report
Door Tan YR, Goh SZF, Koh YH en 1 anderen.
Inhoud in het Engels
Abstract
Introduction
Motor complication in immunocompetent individuals with varicella zoster virus (VZV) reactivation is uncommon and may mimic a compressive spinal disorder.
Case presentation
A 77-year-old immunocompetent woman presented with an acute left foot drop preceded by coryzal symptoms and lower back pain. A vesicular rash developed over the left foot one week after the weakness began. Examination showed a predominantly severe left ankle dorsiflexion weakness with reduced sensation over the L5 and S1 dermatomes. A noncontrast magnetic resonance imaging (MRI) of the lumbosacral spine showed noncompressive degenerative changes. Cerebrospinal fluid (CSF) analysis showed lymphocytic pleocytosis, elevated protein, a reduced CSF-to-serum glucose ratio, and isolated VZV DNA on the polymerase chain reaction (PCR). VZV DNA was also detected from a vesicle swab. She received 14 days of intravenous acyclovir with neuropathic analgesia. A nerve conduction study and electromyography (NCS/EMG) at three months showed a severe left common peroneal neuropathy with sciatic nerve involvement. There was an initial slow motor recovery with persisting neuropathic pain, but only a residual moderate ankle dorsiflexion weakness remained at 9 months.