Li Man, Wang Xingyu, Chen Mojun, Chang Yuan, Li Linfeng, Zhong Shan
Department of Dermatology, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Dermatology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, People's Republic of China.
Infect Drug Resist. 2022 Aug 22;15:4759-4762. doi: 10.2147/IDR.S374981. eCollection 2022.
Bickerstaff brainstem encephalitis (BBE) is a rare demyelinating disease of the central nervous system (CNS) that is caused by a direct viral infection or secondary autoimmune responses. BBE secondary to Herpes zoster has rarely been reported.
A 68-year-old man developed a painful vesicular rash and drooping eyelid on the left side of his face for 20 days. Physical examination revealed left-sided blepharoptosis and crusted erythema on the left front side of his face, left upper eyelid, and left nasal tip. Neurological examination showed impaired sensation over the left side of his face and cheek. His left pupil was dilated (4mm compared to 2mm on the right side), and the Pupillary light reflection (PLR) was absent, with an ocular movement disorder (limited adduction) and diplopia. Brain imaging did not reveal abnormalities. Cerebrospinal fluid (CSF) examination showed leukocytosis and increased protein levels. He was treated with intravenous acyclovir for 7 days, but developed disturbance of consciousness and right limb weakness. Neurological examination revealed right lower limb hypoesthesia. The Heel-Knee-Shin test was positive on the left side, and Babinski's sign was present on the right side. He was diagnosed with Bickerstaff brainstem encephalitis caused by herpes zoster. After 2 days of intravenous acyclovir combined with intravenous immune globulin (IVIG), the patient developed acute kidney injury (AKI). Then, his treatment was changed to systemic steroids. At the 3-month follow-up, his pupils were bilaterally equal and reactive to light, and there was a significant improvement in ocular motility and ptosis. At the 6-month follow-up, his diplopia had completely resolved.
BBE associated with herpes zoster is very rare and can be overlooked. Dermatologists should be aware of the expanding spectrum of neurological complications caused by varicella zoster virus (VZV) infections to aid early diagnosis and treatment.
比克斯特拉夫脑干脑炎（BBE）是一种罕见的中枢神经系统（CNS）脱髓鞘疾病，由直接病毒感染或继发性自身免疫反应引起。继发于带状疱疹的BBE鲜有报道。
一名68岁男性左侧面部出现疼痛性水疱皮疹和上睑下垂20天。体格检查发现左侧睑下垂以及左侧面部、左上睑和左鼻尖结痂性红斑。神经系统检查显示左侧面部和颊部感觉减退。左侧瞳孔散大（4mm，右侧为2mm），瞳孔对光反射（PLR）消失，伴有眼球运动障碍（内收受限）和复视。脑部影像学检查未发现异常。脑脊液（CSF）检查显示白细胞增多和蛋白水平升高。给予静脉注射阿昔洛韦治疗7天，但出现意识障碍和右下肢无力。神经系统检查发现右下肢感觉减退。左侧跟膝胫试验阳性，右侧巴氏征阳性。他被诊断为带状疱疹所致的比克斯特拉夫脑干脑炎。静脉注射阿昔洛韦联合静脉注射免疫球蛋白（IVIG）2天后，患者发生急性肾损伤（AKI）。随后，其治疗改为全身使用类固醇。在3个月的随访中，他的双侧瞳孔等大且对光反应正常，眼球运动和上睑下垂有显著改善。在6个月的随访中，他的复视已完全消失。
与带状疱疹相关的BBE非常罕见，可能被忽视。皮肤科医生应了解水痘带状疱疹病毒（VZV）感染引起的神经系统并发症范围不断扩大，以帮助早期诊断和治疗。
