Neurology Department, Mongi Ben Hamida Institute of Neurology, University of Tunis El Manar, Omar Chedly Street 1029, Bab Saâdoun, Tunis, Tunisia.
J Neurovirol. 2022 Jun;28(3):456-459. doi: 10.1007/s13365-022-01080-5. Epub 2022 May 23.
The triggering effect of herpes simplex virus infection on the development of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is now well established. However, there are very few reports that has linked a varicella zoster virus (VZV) reactivation with anti-NMDAR encephalitis. In this report, we describe a case of a 57-year-old man presented with atypical clinical presentation of anti-NMDAR encephalitis with gait ataxia, complete ophtalmoplegia, and abolished reflexes followed by drowsiness and confusion. Initial diagnosis of Bickerstaff's brainstem encephalitis was suspected. Few days later, the patient developed herpes zoster in a localized right T1-T2 dermatome. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for VZV was negative. CSF anti-NMDA antibodies were proved positive. A diagnosis of anti-NMDAR encephalitis with concomitant VZV skin reactivation was retained. Favorable outcome with combined antiviral treatment and immunomodulatory therapy was observed. Concomitant VZV reactivation with autoimmune encephalitis is possible. Prognosis and therapeutic options in this rare condition remain to be clarified.
单纯疱疹病毒感染触发抗 N-甲基-D-天冬氨酸受体（NMDAR）脑炎的发展现已得到充分证实。然而，很少有报道将水痘带状疱疹病毒（VZV）再激活与抗 NMDAR 脑炎联系起来。在本报告中，我们描述了一例 57 岁男性病例，表现为抗 NMDAR 脑炎的非典型临床特征，包括步态共济失调、完全眼肌麻痹、反射消失，随后出现嗜睡和意识混乱。最初怀疑为 Bickerstaff 脑干脑炎。几天后，患者在右侧 T1-T2 皮节出现带状疱疹。脑脊液（CSF）聚合酶链反应（PCR）检测 VZV 为阴性。CSF 抗 NMDA 抗体阳性。诊断为抗 NMDAR 脑炎伴 VZV 皮肤再激活。联合抗病毒治疗和免疫调节治疗观察到良好的预后。自身免疫性脑炎可能与 VZV 再激活同时发生。这种罕见情况下的预后和治疗选择仍需阐明。
