Ahmed Syed Viqar, Hamada Hazim, Jayawarna Chaminda, Chandra Sumit
Acute Medicine Unit, Stepping Hill Hospital, Stockport, UK.
BMJ Case Rep. 2012 May 30;2012:bcr0320126041. doi: 10.1136/bcr.03.2012.6041.
A 32-year-old married Asian woman, previously fit and well, presented with a 3-day history of interscapular back pain followed by a 1-day history of frontal headache and a few episodes of vomiting. She did not have photophobia or neck stiffness. On examination, there was evidence of herpes zoster infection involving the right T3 dermatome. There were no signs of meningeal irritation, cognitive impairment or any neurological deficit. As it is uncommon to have reactivation of herpes zoster infection at a young age, HIV serology was requested to exclude immunodeficiency state. While awaiting serology, a lumbar puncture was performed to exclude opportunistic infections of the central nervous system as she had transient headache and vomiting at the onset. The cerebrospinal fluid showed an elevated level of protein, an increase in lymphocytes and a strongly positive PCR for varicella zoster. The HIV test was negative. Oral acyclovir was changed to intravenous therapy and, a week later, she was discharged with uneventful recovery.
一名32岁已婚亚洲女性，既往身体健康，出现肩胛间区背痛3天，随后出现前额头痛1天，并伴有几次呕吐发作。她没有畏光或颈部僵硬症状。检查时，有证据表明带状疱疹感染累及右侧T3皮区。没有脑膜刺激征、认知障碍或任何神经功能缺损的体征。由于年轻时带状疱疹感染再激活并不常见，因此要求进行HIV血清学检查以排除免疫缺陷状态。在等待血清学检查结果期间，由于她在发病初期有短暂的头痛和呕吐症状，进行了腰椎穿刺以排除中枢神经系统的机会性感染。脑脊液显示蛋白水平升高、淋巴细胞增多，水痘带状疱疹病毒PCR检测呈强阳性。HIV检测为阴性。口服阿昔洛韦改为静脉治疗，一周后，她康复出院。
