Lameiras Catarina, Patrocínio de Jesus Rita, Flor-de-Lima Bárbara, Silva Joana, Pacheco Patrícia
Internal Medicine, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT.
Infectious Diseases, Hospital Professor Doutor Fernando Fonseca, Amadora, PRT.
Cureus. 2022 Aug 3;14(8):e27652. doi: 10.7759/cureus.27652. eCollection 2022 Aug.
Varicella-zoster virus (VZV) myelitis is a rare complication of herpes zoster. Diagnosing and treating this entity may be challenging. Clinical outcomes vary and neurological sequelae may be seen despite treatment. We report a case of a 43-year-old woman with human immunodeficiency virus type 1 (HIV-1) infection (CD4 cell count 191 cells/µL - 14%; undetectable viral load) who was started on antiretroviral treatment eight months before. She presented with VZV meningitis and transverse myelitis and concomitant thoracic vesicular rash at the dermatomal level T6. Neurological examination revealed neck stiffness, paraplegia, sensory level below T4, and autonomic dysfunction. Magnetic resonance imaging (MRI) revealed signs of myelitis from C4 to T10 and VZV DNA by polymerase chain reaction (PCR) was positive (20,00,000 cp/mL) in the cerebrospinal fluid (CSF). The patient completed four weeks of intravenous acyclovir and systemic corticosteroids. Repeat lumbar puncture returned negative for VZV PCR and MRI showed spinal cord improvement. However, only partial neurological improvement was observed after six months. Some features of the present case may be associated with an unfavorable outcome, including high VZV viral load in the CSF and rapid progression of neurological deficits to paraplegia and sphincter dysfunction. Moreover, the recovery of CD4+ cells from 4% to 14% after starting antiretroviral treatment might also have contributed to the extension of myelopathy. Further studies are needed to improve the understanding of VZV myelitis course and optimize its treatment.
水痘-带状疱疹病毒（VZV）脊髓炎是带状疱疹的一种罕见并发症。诊断和治疗这种疾病可能具有挑战性。临床结果各不相同，即使经过治疗也可能出现神经后遗症。我们报告一例43岁女性，感染1型人类免疫缺陷病毒（HIV-1）（CD4细胞计数为191个/微升 - 14%；病毒载量检测不到），在八个月前开始接受抗逆转录病毒治疗。她出现了VZV脑膜炎和横贯性脊髓炎，并伴有T6皮节水平的胸部水疱疹。神经系统检查发现颈部僵硬、截瘫、T4以下感觉平面以及自主神经功能障碍。磁共振成像（MRI）显示从C4到T10有脊髓炎迹象，脑脊液（CSF）中通过聚合酶链反应（PCR）检测VZV DNA呈阳性（2000000拷贝/毫升）。患者完成了四周的静脉注射阿昔洛韦和全身使用皮质类固醇治疗。重复腰椎穿刺VZV PCR结果为阴性，MRI显示脊髓有所改善。然而，六个月后仅观察到部分神经功能改善。本病例的一些特征可能与不良预后相关，包括脑脊液中VZV病毒载量高以及神经功能缺损迅速进展为截瘫和括约肌功能障碍。此外，开始抗逆转录病毒治疗后CD4 +细胞从4%恢复到14%也可能导致了脊髓病的扩展。需要进一步研究以更好地理解VZV脊髓炎的病程并优化其治疗。
