Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
J Neurol Sci. 2019 May 15;400:186-187. doi: 10.1016/j.jns.2019.04.001. Epub 2019 Apr 2.
Acute cerebellitis is a well recognized complication of varicella zoster virus (VZV) infection in children. It has been described in adults in the setting of virus reactivation with a preceding herpes zoster rash, but it is exceedingly rare in adults who are not elderly or immunocompromised, particularly in the absence of a rash. To our knowledge, there has been only one reported case of acute cerebellitis in an immunocompetent adult less than age 65 with virological confirmation of acute VZV infection. We describe a 59-year-old immunocompetent man who presented with acute truncal ataxia without rash and was diagnosed with VZV cerebellitis, supported by anti-VZV IgM and anti-VZV IgG antibodies in the serum and a positive VZV polymerase chain reaction in cerebrospinal fluid. He had robust improvement with intravenous acyclovir treatment and was free of neurologic disability at two month follow-up. This case highlights the importance of virological evaluation in patients with acute ataxia, even in the absence of typical features of infection.
急性小脑炎是儿童水痘带状疱疹病毒（VZV）感染的一种公认并发症。在疱疹病毒重新激活并伴有带状疱疹皮疹的成人中已有相关描述，但在没有皮疹的情况下，非老年或免疫功能低下的成年人中极为罕见。据我们所知，仅有一例免疫功能正常的 65 岁以下成年人报道，经病毒学证实存在急性 VZV 感染，表现为急性小脑炎。我们描述了一例 59 岁免疫功能正常的男性，表现为急性躯干共济失调，无皮疹，并通过血清抗 VZV IgM 和抗 VZV IgG 抗体以及脑脊液中 VZV 聚合酶链反应阳性，确诊为 VZV 小脑炎。他在接受静脉用阿昔洛韦治疗后有明显改善，在两个月随访时无神经功能障碍。该病例强调了对急性共济失调患者进行病毒学评估的重要性，即使没有典型的感染特征也是如此。
