Gnoni Martin, Zaheer Kamran, Vasser Melinda M, Singh Monider, Ajmeri Aman, Harter Stephanie R, Mughees Rana Abdul, Aguilar Rodrigo
Our Lady of Bellefonte Hospital, 1000 St Christopher Dr, Ashland, KY 41101, United States.
Marshall University, MU Internal Medicine Residency Program, 1249 15th Street, Huntington, WV 25701, United States.
IDCases. 2018 Aug 25;13:e00446. doi: 10.1016/j.idcr.2018.e00446. eCollection 2018.
Varicella Zoster when described has the typical presentation of a dermatomal distribution of a rash and can further lead to CNS complications. This can be treated accordingly with the proper protocol, but if the presentation is atypical and the protocol is challenged or changed per specific patient outcomes, new developments can occur. Here we present a case of a 29-year-old Caucasian female that presented to the emergency department with headache, photophobia, and chills for 5 days. She was previously healthy and immunocompetent; CSF PCR analysis revealed a VZV infection causing acute aseptic meningitis with no shingles rash eruption on physical examination. The patient was not willing to stay hospitalized for the duration of the treatment. This gave us an opportunity to treat her with an oral, rather than IV, antiviral. The patient was successfully treated with oral valacyclovir 2 g Q6H after only receiving two days of IV acyclovir. To the best of our knowledge, this is the first reported case of a patient with VZV-associated meningitis successfully treated with oral valacyclovir.
水痘带状疱疹在被描述时具有皮疹呈皮节分布的典型表现，并可能进一步导致中枢神经系统并发症。这可以按照适当的方案进行相应治疗，但如果表现不典型且方案根据特定患者的结果受到挑战或改变，就可能出现新的情况。在此，我们报告一例29岁的白种女性病例，该患者因头痛、畏光和寒战5天就诊于急诊科。她之前身体健康且免疫功能正常；脑脊液聚合酶链反应分析显示水痘带状疱疹病毒感染导致急性无菌性脑膜炎，体格检查未发现带状疱疹皮疹。该患者不愿意在整个治疗期间住院。这使我们有机会用口服而非静脉注射的抗病毒药物对她进行治疗。该患者仅接受了两天的静脉注射阿昔洛韦后，就成功地接受了口服伐昔洛韦治疗，剂量为2克，每6小时一次。据我们所知，这是第一例报告的成功用口服伐昔洛韦治疗水痘带状疱疹病毒相关性脑膜炎的患者。
