Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Emerg Med. 2021 May;60(5):e99-e101. doi: 10.1016/j.jemermed.2020.12.029. Epub 2021 Feb 10.
Varicella-zoster virus is typically encountered in the emergency department (ED) in two forms: varicella (chickenpox) in children and zoster (shingles) in older adults. Zoster is infrequently encountered in young, healthy adults, and neurological complications are extremely rare.
We describe a case of a previously healthy 36-year-old woman who presented to the ED with fever, nuchal rigidity, and headache 4 days after being diagnosed with herpes zoster and started on oral valacyclovir. Lumbar puncture confirmed herpes zoster meningitis. Despite initiation of antivirals within 48 h of symptom onset, progression to zoster meningitis occurred. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must be aware that neurological complications of varicella zoster can develop despite initiation of oral antivirals. These patients must be identified in the ED, as admission for intravenous antivirals is indicated.
水痘-带状疱疹病毒在急诊科（ED）通常以两种形式出现：儿童的水痘（带状疱疹）和老年人的带状疱疹（带状疱疹）。带状疱疹在年轻、健康的成年人中很少见，且神经并发症极为罕见。
我们描述了一例既往健康的 36 岁女性，她在诊断为带状疱疹并开始口服伐昔洛韦后 4 天出现发热、颈项强直和头痛，到急诊科就诊。腰椎穿刺证实为带状疱疹性脑膜炎。尽管在症状出现后 48 小时内开始使用抗病毒药物，但仍进展为带状疱疹性脑膜炎。
为什么急诊医生应该注意这一点？：急诊医生必须意识到，即使开始口服抗病毒药物，水痘带状疱疹的神经并发症仍可能发生。这些患者必须在急诊科得到识别，因为需要入院接受静脉用抗病毒药物治疗。
