Hu Yaozhi, Zhong Mengfei, Hu Mengliang, Zhang Ligong
Department of Neurology, Shengli Oilfield Central Hospital, Dongying, Shandong 257000, P.R. China.
Department of Neurology, Binzhou Medical University, Binzhou, Shandong 256603, P.R. China.
Exp Ther Med. 2024 Jul 30;28(4):380. doi: 10.3892/etm.2024.12669. eCollection 2024 Oct.
Although central nervous system infection following varicella zoster virus infection is relatively common, subsequent peripheral nervous system infection is comparatively rare. The present case documents a case of meningitis after varicella-zoster virus (VZV) infection, which was then followed by peripheral facial palsy. Specifically, a 54-year-old female patient was first admitted to Shengli Oilfield Central Hospital (Dongying, China) with headache and fever. Physical examination revealed herpes that formed along the intercostal nerve in the left forebreast, armpit and back. Subsequently, neurological examination found cervical resistance in more than three fingers (neck resistance of less than two transverse fingers is not evidence of meningeal irritation; the neck resistance of this patient was approximately three transverse fingers, so the patient was presumed to be positive for meningeal irritation, highly suggestive of meningitis) and Kernig sign was positive. There were no significant abnormalities according to brain MRI and lumbar puncture pressure was 330 mmHO. In addition, the leukocyte count was 734x10/l, 50% monocyte count, 50% multinucleated cells, chloride levels of 109.1 mmol/l, protein levels of 235 mg/dl and glucose levels of 4.18 mmol/l in the cerebrospinal fluid. DNA and RNA metagenomic detection of pathogenic microorganisms in the cerebrospinal fluid revealed the presence of VZV. The patient was therefore treated with acyclovir, ceftriaxone, mannitol and methylprednisolone, but then developed right peripheral facial palsy at 10 days after treatment. This complication was not found in the literature, and the occurrence of facial neuritis was unexpected. The active period of VZV virus was 21 days, and the patient had herpes 5 days before admission. The active period of the virus was considered to have subsided and the patient was in the recovery period. Moreover, the results of lumbar puncture showed that the white blood cells, the proportion of neutrophils and the protein in cerebrospinal fluid were all decreasing, which also indicated that the patient had entered the recovery period. The patient was discharged 18 days after admission. In conclusion, observations from the present case suggested that the clinical manifestations of VZV infection can be complex and varied, requiring the clinician to have an accurate understanding of its disease progression and treatment.
虽然水痘带状疱疹病毒感染后中枢神经系统感染相对常见，但随后的外周神经系统感染则较为罕见。本病例记录了1例水痘带状疱疹病毒（VZV）感染后发生脑膜炎，随后出现外周性面瘫的病例。具体情况为，一名54岁女性患者最初因头痛和发热入住胜利油田中心医院（中国东营）。体格检查发现左前胸部、腋窝及背部沿肋间神经出现疱疹。随后，神经学检查发现颈部抵抗超过三横指（颈部抵抗小于两横指不是脑膜刺激征的证据；该患者颈部抵抗约为三横指，因此推测该患者脑膜刺激征阳性，高度提示脑膜炎），凯尔尼格征阳性。脑MRI未发现明显异常，腰穿压力为330 mmH₂O。此外，脑脊液中白细胞计数为734×10⁶/L，单核细胞计数50%，多核细胞50%，氯化物水平为109.1 mmol/L，蛋白水平为235 mg/dl，葡萄糖水平为4.18 mmol/L。脑脊液中病原微生物的DNA和RNA宏基因组检测显示存在VZV。因此，该患者接受了阿昔洛韦、头孢曲松、甘露醇和甲泼尼龙治疗，但在治疗10天后出现了右侧外周性面瘫。这种并发症在文献中未被发现，且面神经炎性发作出乎意料。VZV病毒的活跃期为21天，患者入院前5天出现疱疹。病毒活跃期被认为已消退，患者处于恢复期。此外，腰穿结果显示脑脊液中的白细胞、中性粒细胞比例和蛋白均在下降，这也表明患者已进入恢复期。患者入院18天后出院。总之，本病例观察结果提示，VZV感染的临床表现可能复杂多样，需要临床医生准确了解其疾病进展及治疗方法。
