Obstetrics-Gynecology, Detroit Medical Center, Detroit, Michigan, USA
Obstetrics-Gynecology, Detroit Medical Center, Hamtramck, Michigan, USA.
BMJ Case Rep. 2021 Feb 23;14(2):e236644. doi: 10.1136/bcr-2020-236644.
We report the case of retrograde varicella zoster virus (VZV) reactivation presenting as aseptic meningitis without rash in a generally healthy pregnant patient. A 27-year-old nulliparous woman at 25 weeks of gestation presented to the emergency department with a 1-day history of severe headache associated with nausea, photophobia and neck stiffness. After ruling out a space-occupying lesion by brain imaging, lumbar puncture was performed. Cerebrospinal fluid analysis by PCR revealed the presence of VZV, making the diagnosis of acute varicella meningitis. The patient had immunoglobulin studies consistent with a history of primary VZV infection, thus confirming reactivation of VZV rather than primary infection. The patient was treated with acyclovir for 14 days and recovered fully. Her neonate was delivered full term without any evidence of vertical transmission. This is only the second reported case of VZV meningitis in a pregnant patient in the medical literature, and the first case in the US that was reported.
我们报告了一例逆行水痘带状疱疹病毒 (VZV) 激活病例，表现为无皮疹的无菌性脑膜炎，发生于一般健康的孕妇。一位 27 岁、初产妇，妊娠 25 周时因剧烈头痛伴恶心、畏光和颈强直就诊于急诊。脑部成像排除占位性病变后，行腰椎穿刺。PCR 脑脊液分析显示存在 VZV，确诊为急性水痘性脑膜炎。患者免疫球蛋白研究提示存在原发性 VZV 感染史，因此证实了 VZV 的再激活而非原发性感染。患者接受阿昔洛韦治疗 14 天，完全康复。她的新生儿足月分娩，无垂直传播证据。这是医学文献中仅有的第二例孕妇 VZV 脑膜炎报告，也是美国首例报告。
