Department of Internal Medicine, University Hospital of Ferrol, A Coruña, Spain.
Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, A Coruña, Spain.
Am J Case Rep. 2022 Jun 6;23:e936707. doi: 10.12659/AJCR.936707.
BACKGROUND Varicella zoster virus (VZV) infection can increase the risk of cerebrovascular disease, involving small and large arteries, especially in immunosuppressed patients with ophthalmic division of the trigeminal nerve involvement. We present the case of a patient with intracerebral VZV vasculopathy without overt clinical manifestation but with abnormal imaging findings in the brain magnetic resonance (MR). CASE REPORT A 59-year-old woman with systemic lupus erythematosus (SLE), without other traditional cardiovascular risk factors, presented to the hospital due to headache, vertical diplopia, decreased of visual acuity of right eye, and disseminated varicella zoster virus (VZV) infection with predominant skin lesions distributed along the ophthalmic division of the right trigeminal nerve. Cerebrospinal fluid (CSF) testing revealed meningitis and positive polymerase chain reaction (PCR) for VZV, and a brain MRI scan showed a right occipital hemorrhagic lesion; thus, she was diagnosed with disseminated VZV infection with neurological involvement. She received intravenous acyclovir for 10 days. One month later, a physical examination was unremarkable and she was asymptomatic, but control brain MR angiography showed stenosis of the right internal carotid and the right middle cerebral artery, compatible with VZV vasculopathy. The PCR for VZV turned negative in CSF but the titers of anti-VZV IgG antibodies in CSF were high, and no increase of plasma autoimmune biomarkers were detected at any time in the course of the clinical evolution. CONCLUSIONS Discordance between imaging findings and clinical manifestations can appear in intracerebral VZV vasculopathy. A differential diagnosis is mandatory, especially if there is underlying immunosuppression.
水痘带状疱疹病毒（VZV）感染会增加发生脑血管病的风险，涉及小动脉和大动脉，尤其是在伴有三叉神经眼支受累的免疫抑制的患者中。我们报告了一例颅内 VZV 血管病患者，其无明显临床表现，但脑部磁共振成像（MR）有异常表现。
一名 59 岁女性，患有系统性红斑狼疮（SLE），无其他传统心血管危险因素，因头痛、垂直复视、右眼视力下降以及广泛性水痘带状疱疹病毒（VZV）感染而就诊，伴有沿右侧三叉神经眼支分布的显性皮肤病变。脑脊液（CSF）检查显示脑膜炎和 VZV 的聚合酶链反应（PCR）阳性，脑部 MRI 扫描显示右侧枕叶出血性病变；因此，她被诊断为伴有神经受累的播散性 VZV 感染。她接受了 10 天的静脉注射阿昔洛韦治疗。一个月后，体格检查无明显异常，她无症状，但控制脑部 MR 血管造影显示右侧颈内动脉和右侧大脑中动脉狭窄，符合 VZV 血管病。CSF 中的 VZV-PCR 转为阴性，但 CSF 中抗 VZV IgG 抗体的滴度较高，在临床病程中的任何时间都未检测到血浆自身免疫生物标志物的增加。
颅内 VZV 血管病可能会出现影像表现与临床表现不相符的情况。必须进行鉴别诊断，尤其是在存在潜在免疫抑制的情况下。
