Le Nancy, Razick Daniel I, Dhaliwal Anand, Akhtar Muzammil, Daniel Emily
Neurology, California Northstate University College of Medicine, Elk Grove, USA.
Surgery, California Northstate University College of Medicine, Elk Grove, USA.
Cureus. 2023 Jul 5;15(7):e41383. doi: 10.7759/cureus.41383. eCollection 2023 Jul.
Varicella-zoster virus (VZV) is a member of the alpha-herpesvirus family, which can occasionally cause severe neurological complications such as encephalitis. In this case report, we discuss a rare finding of VZV encephalitis in which an immunocompetent pediatric patient, vaccinated against varicella, presented with altered mental status and no vesicular rash. A 15-year-old male presented to the Emergency Department with progressively worsening altered mental status over the past three days. The patient's mother stated that he was exhibiting frequent memory lapses as well as the sudden loss of the ability to play the piano. After admission to the pediatric general floor, lumbar puncture was performed and cerebrospinal fluid analysis returned positive for VZV, confirmed by polymerase chain reaction. The patient was then started on intravenous (IV) acyclovir at a dose of 650 mg every 8 hours to treat VZV-induced encephalitis. While the patient continued to have intermittent episodes of confusion and headaches, his overall condition improved, and by day 4, he was able to resume playing the piano and ukulele. The patient was discharged on day 8 with no home medications, and a follow-up with this primary care physician was scheduled. This patient is one of only four recorded cases of VZV encephalitis in immunocompetent children. It is extremely rare to encounter pediatric patients with this diagnosis and, as such, can elude physicians when developing differential diagnoses. If VZV is suspected, a lumbar puncture should be performed promptly, and, if confirmed, IV acyclovir should be started. Furthermore, this case highlights the need for future research with regard to VZV and potential predisposing factors in immunocompetent patients.
水痘带状疱疹病毒（VZV）是α疱疹病毒家族的成员，偶尔可引起严重的神经系统并发症，如脑炎。在本病例报告中，我们讨论了一例罕见的VZV脑炎病例，该病例为一名接种过水痘疫苗的免疫功能正常的儿科患者，表现为精神状态改变且无皮疹。一名15岁男性因过去三天精神状态逐渐恶化就诊于急诊科。患者母亲称他频繁出现记忆丧失，以及突然丧失弹钢琴的能力。入住儿科普通病房后，进行了腰椎穿刺，脑脊液分析VZV呈阳性，经聚合酶链反应确认。然后开始以每8小时650毫克的剂量静脉注射阿昔洛韦治疗VZV引起的脑炎。虽然患者仍有间歇性的意识模糊和头痛发作，但总体状况有所改善，到第4天时，他能够重新弹钢琴和尤克里里。患者于第8天出院，无需服用家庭药物，并安排了与初级保健医生的随访。该患者是免疫功能正常儿童中仅有的四例有记录的VZV脑炎病例之一。遇到这种诊断的儿科患者极为罕见，因此在制定鉴别诊断时可能会被医生忽视。如果怀疑是VZV，应立即进行腰椎穿刺，如果确诊，应开始静脉注射阿昔洛韦。此外，该病例凸显了未来对VZV以及免疫功能正常患者潜在易感因素进行研究的必要性。
