Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO, USA.
J Neurol Sci. 2010 May 15;292(1-2):85-8. doi: 10.1016/j.jns.2010.01.019. Epub 2010 Feb 19.
We describe an immunocompetent 45-year-old woman who had four episodes of neurological disease (meningoencephalitis, multifocal vasculopathy, myelitis and inflammatory brain stem disease) produced by varicella zoster virus (VZV) over an 11-month period, all in the absence of rash. The cerebrospinal fluid (CSF) contained anti-VZV IgG antibody, but not VZV DNA throughout her illness, reaffirming the superiority of detection of anti-VZV IgG in CSF compared to VZV DNA in diagnosing VZV infection of the nervous system. Moreover, 3 of 7 CSF samples examined during the 11 months showed a VZV-induced pleocytosis consisting predominantly of polymorphonuclear cells (PMNs), and 4 of 7 samples also contained increased numbers of red blood cells (RBCs). Because increased PMNs and RBCs in CSF can also occur in patients with central and peripheral nervous system disease produced by cytomegalovirus (CMV), the differential diagnosis of chronic nervous system infection with increased PMNs and RBCs in CSF should include analyses for both VZV and CMV.
我们描述了一位免疫功能正常的 45 岁女性，在 11 个月的时间内，由水痘带状疱疹病毒（VZV）引起了 4 次神经系统疾病（脑膜炎、多灶性血管病、脊髓炎和炎症性脑干疾病），均无皮疹。整个病程中，脑脊液（CSF）中含有抗 VZV IgG 抗体，但未检测到 VZV DNA，这再次证实了在诊断 VZV 感染神经系统时，CSF 中抗 VZV IgG 的检测优于 VZV DNA。此外，在 11 个月期间检查的 7 份 CSF 样本中的 3 份显示出 VZV 诱导的白细胞增多症，主要为多形核细胞（PMN），并且 7 份样本中的 4 份还含有红细胞（RBC）数量增加。因为 CSF 中PMN 和 RBC 的增加也可能发生在巨细胞病毒（CMV）引起的中枢和周围神经系统疾病患者中，因此 CSF 中PMN 和 RBC 增加的慢性神经系统感染的鉴别诊断应包括 VZV 和 CMV 的分析。
