Sato Tetsuko, Yamamoto Takenobu, Aoyama Yumi
Department of Dermatology, Kawasaki Medical School, Kurashiki, Japan.
Department of Dermatology, Kawasaki Medical School General Medical Center, Kurashiki, Japan.
Case Rep Dermatol. 2021 Feb 26;13(1):148-153. doi: 10.1159/000512710. eCollection 2021 Jan-Apr.
Varicella zoster virus (VZV)-associated meningitis is usually progressive and can be fatal, and early diagnosis and aggressive treatment with intravenous antivirals such as acyclovir (ACV) are required in immunocompromised patients. Patients receiving corticosteroids and immunosuppressive therapy have a significantly higher risk of VZV-associated meningitis. In this report, we describe an unusual case of herpes zoster (HZ) in a young woman who was first diagnosed during tapering of prednisone for dermatomyositis. The skin lesions affected the left L2 and L3 dermatomes, which is unusual in VZV-associated meningitis. Despite showing a good rapid response to antivirals, she developed VZV-associated meningitis immediately after discontinuation of ACV. This phenomenon is often called rebound VZV reactivation disease and occurs after discontinuation of antivirals. This case was notable in that the affected dermatomes were distant from the cranial nerves. Thus, progression of HZ to VZV reactivation-associated meningitis can occur even in appropriately treated HZ patients. Continuation of antivirals beyond 1 week in patients on immunosuppressive therapy may be associated with a decreased risk of severe rebound VZV disease, such as VZV-associated meningitis.
水痘带状疱疹病毒（VZV）相关脑膜炎通常呈进行性发展，可能致命，免疫功能低下的患者需要早期诊断并积极使用静脉抗病毒药物（如阿昔洛韦）进行治疗。接受皮质类固醇和免疫抑制治疗的患者发生VZV相关脑膜炎的风险显著更高。在本报告中，我们描述了一名年轻女性的不寻常带状疱疹（HZ）病例，她最初是在逐渐减少用于治疗皮肌炎的泼尼松剂量时被诊断出来的。皮肤病变累及左侧L2和L3皮节，这在VZV相关脑膜炎中并不常见。尽管对抗病毒药物显示出良好的快速反应，但在停用阿昔洛韦后，她立即发生了VZV相关脑膜炎。这种现象通常被称为VZV再激活反弹疾病，发生在停用抗病毒药物之后。该病例的显著之处在于受累皮节远离颅神经。因此，即使是接受了适当治疗的HZ患者，HZ也可能进展为VZV再激活相关脑膜炎。免疫抑制治疗患者抗病毒药物使用超过1周可能会降低严重VZV反弹疾病（如VZV相关脑膜炎）的风险。
