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Disseminated cutaneous herpes zoster and multiple cerebral infarcts in an adult with diabetes mellitus

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Abstract

Ischemic stroke is a rare complication of varicella-zoster virus (VZV) infection. We present the case of a patient with a medical history of type 2 diabetes mellitus (DM) who experienced disseminated cutaneous VZV infection followed by multiple cerebral infarcts associated with VZV vasculopathy. Brain magnetic resonance imaging revealed multiple hyperintense lesions over the bilateral deep white matter and basal ganglia. A skin biopsy revealed small-vessel leukocytoclastic vasculitis with neutrophilic, lymphocytic, and eosinophilic infiltration. This case report describes the rare finding of cutaneous leukocytoclastic vasculitis in VZV infection and highlights that VZV infection is an uncommon but critical etiology of cryptogenic stroke in patients with DM.

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Abbreviations

VZV:

Varicella zoster virus

DM:

Diabetes mellitus

IgM:

Immunoglobulin M

MRI:

Magnetic resonance imaging

FLAIR:

Fluid-attenuated inversion recovery

DWI:

Diffusion-weighted imaging

CSF:

Cerebrospinal fluid

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Acknowledgments

This manuscript was edited by Wallace Academic Editing.

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Authors and Affiliations

  1. Department of Neurology, Shuang Ho Hospital, Taipei Medical University, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, 23561, Taiwan

    Chun-Fu Lin, Chien-Tai Hong, Dean Wu, Chaur-Jong Hu & Chen-Chih Chung

  2. Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan

    Chun-Fu Lin, Chien-Tai Hong, Dean Wu, Chaur-Jong Hu & Chen-Chih Chung

  3. Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Chien-Tai Hong, Dean Wu, Chaur-Jong Hu & Chen-Chih Chung

  4. Department of pathology, Shuang Ho Hospital, Taipei, Medical University, Taipei, Taiwan

    Wei-Hwa Lee

  5. Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan

    Chen-Chih Chung

Authors
  1. Chun-Fu Lin
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  2. Chien-Tai Hong
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  3. Wei-Hwa Lee
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  4. Dean Wu
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  5. Chaur-Jong Hu
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  6. Chen-Chih Chung
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Corresponding author

Correspondence to Chen-Chih Chung.

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The study was approved by the Taipei Medical University Joint Institutional Review Board (No. N20190387).

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The authors declare that they have no conflict of interest.

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Lin, CF., Hong, CT., Lee, WH. et al. Disseminated cutaneous herpes zoster and multiple cerebral infarcts in an adult with diabetes mellitus. J. Neurovirol. 26, 130–132 (2020). https://doi.org/10.1007/s13365-019-00790-7

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  • DOI: https://doi.org/10.1007/s13365-019-00790-7

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