Neurological Sciences

, Volume 29, Issue 4, pp 279–283 | Cite as

Varicella zoster virus meningo-encephalo-myelitis in an immunocompetent patient

  • Eleonora Tavazzi
  • Lorenzo Minoli
  • Pasquale Ferrante
  • Paola Scagnelli
  • Serena Del Bue
  • Alfredo Romani
  • Sabrina Ravaglia
  • Enrico MarchioniEmail author
Brief Communication



To describe clinical, MRI and cerebrospinal fluid (CSF) features of a varicella zoster virus (VZV) related meningo-encephalo-myelitis (MEM) without rash in an immunocompetent female.


An 85 year old immunocompetent woman with mild hyperthermia and acute, severe MEM.


Serum antibodies and CSF PCR were searched for several viruses. Brain and spinal cord MRI were performed. Immunological profile.


i.v. acyclovir 30 mg/kg/day; i.v. 6-MP 125 mg/day.


Marked CSF lymphomonocytic pleocytosis, blood-brainbarrier damage, and PCR detection of 3.05 X 10 6 copies of VZV DNA. MRI revealed lesions of the meninges, brain and spinal cord. No evidence of immunosuppression.


We highlight the importance of considering the possibility of VZV related MEM, even in immunocompetent patients. We also provide a MRI description of VZV related multifocal myelitis, not previously available. As supported by other reports, we underline the necessity of a prompt therapeutic intervention in this life-threatening condition.


Varicella-zoster Meningitis Encephalomyelitis Immunocompetence Vasculitis 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ et al (2000) Neurologic complications of the reactivation of Varicella-Zoster virus. N Engl J Med 342:635–646PubMedCrossRefGoogle Scholar
  2. 2.
    Kleinschmidt-DeMasters BK, Amlie-Lefond C, Gilden DH (1996) The patterns of VZV encephalitis. Hum Pathol 27:927–938PubMedCrossRefGoogle Scholar
  3. 3.
    Gray F, Belec L, Lescs MC et al (1994) Varicella-zoster virus infection of the central nervous system in the acquired immune deficiency syndrome. Brain 117:987–999PubMedCrossRefGoogle Scholar
  4. 4.
    Gilden DH, Mahalingam R, Cohrs RJ et al (2002) The protean manifestations of varicella-zoster virus vasculopathy. J Neurovirol 8[Suppl 2]:75–79PubMedCrossRefGoogle Scholar
  5. 5.
    Cinque P, Bossolasco S, Vago L et al (1997) Varicella-Zoster virus DNA in cerebrospinal fluid of patients infected with Human Immunodeficiency Virus: VZV disease of the central nervous system or subclinical reactivation of VZV infection? Clin Infect Dis 25:634–639PubMedCrossRefGoogle Scholar
  6. 6.
    Marchioni E, Ravaglia S, Piccolo G et al (2005) Postinfectious inflammatory disorders: subgroups based on prospective follow-up. Neurol 65:1057–1065CrossRefGoogle Scholar
  7. 7.
    Aberle SW, Aberle JH, Steininger C et al (2005) Quantitative real time PCR detection of Varicella-zoster virus DNA in cerebrospinal fluid in patients with neurological disease. Med Microbiol Immunol 194:7–12PubMedCrossRefGoogle Scholar
  8. 8.
    Outteryck O, Sénéchal O, Berteloot D (2005) Cerebral vasculitis secondary to Varicella-Zoster virus infection Rev Neurol (Paris) 161:836–839Google Scholar
  9. 9.
    Goldberg JW (1997) Primary angiitis of the central nervous system. In: Rolak LA, Harati Y (eds) Neuroimmunology for the clinician, Butterworth Heinemann, Boston, pp 177–186Google Scholar
  10. 10.
    Scheld WM, Whitley RJ, Marra CM (2004) Infections of the central nervous system, 3rd edn, Lippincott Williams & Wilkins, PhiladelphiaGoogle Scholar
  11. 11.
    Amlie-Lefond C, Kleinschmidt-DeMasters BK, Mahalingam R et al (1995) The vasculopathy of varicella-zoster virus encephalopathy. Ann Neurol 37:784–790PubMedCrossRefGoogle Scholar
  12. 12.
    Sissoko D, Bellagra N, Dewilde A et al (1998) Varicella-zoster virus meningo-encephalomyelitis without skin eruption. Ann Biol Clin 56:211–212Google Scholar
  13. 13.
    Mancardi GL, Melioli G, Traverso F et al (1987) Zoster sine herpete causing encephalomyelitis. Italian J Neurol Sci 8:67–70CrossRefGoogle Scholar
  14. 14.
    Devinsky O, Cho ES, Petito CK et al (1991) Herpes Zoster myelitis. Brain 114:1181–1196PubMedCrossRefGoogle Scholar
  15. 15.
    Russman AN, Lederman RJ, Calabrese LH et al (2003) Multifocal varicella zoster virus vasculopathy without rash. Arch Neurol 60:1607–1069PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2008

Authors and Affiliations

  • Eleonora Tavazzi
    • 1
  • Lorenzo Minoli
    • 2
  • Pasquale Ferrante
    • 3
    • 4
  • Paola Scagnelli
    • 5
  • Serena Del Bue
    • 3
  • Alfredo Romani
    • 1
  • Sabrina Ravaglia
    • 1
  • Enrico Marchioni
    • 1
    Email author
  1. 1.Department of Clinical Neurology“C. Mondino” IRCCS FoundationPaviaItaly
  2. 2.Department of Infectious Diseases“Policlinico San Matteo” IRCCS FoundationPaviaItaly
  3. 3.Laboratory of Virology Department of Biomolecular Science and TechnologyUniversity of MilanMilanItaly
  4. 4.San Giuseppe HospitalMilanItaly
  5. 5.Department of Neuroradiology“Policlinico San Matteo” IRCCS FoundationPaviaItaly

Personalised recommendations