Einhorn Nathan, Grover Aditya, Hernandez Leo, Marsh Jennifer
Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, USA.
Pharmacotherapeutics and Clinical Research, University of South Florida Taneja College of Pharmacy, Tampa, USA.
Cureus. 2025 May 7;17(5):e83689. doi: 10.7759/cureus.83689. eCollection 2025 May.
Varicella-zoster virus (VZV) myelitis is a rare but serious complication of VZV reactivation that can lead to significant neurological deficits. While antiviral therapy is the mainstay of treatment, the role of corticosteroids remains unclear. We present a case of a 30-year-old male who developed progressive asymmetric lower-extremity weakness, constipation, and urinary retention without a dermatomal rash in the setting of HIV/AIDS. MRI revealed longitudinally extensive transverse myelitis, and cerebrospinal fluid (CSF) analysis confirmed VZV reactivation. The patient was treated with ganciclovir and high-dose corticosteroids, leading to an initial neurological improvement. This case highlights the potential benefit of adjunctive corticosteroid therapy in reducing inflammation and improving outcomes in VZV myelitis. Given the lack of standardized treatment guidelines, further studies are needed to clarify the role of corticosteroids and optimize management strategies for this condition.
水痘-带状疱疹病毒（VZV）脊髓炎是VZV再激活的一种罕见但严重的并发症，可导致明显的神经功能缺损。虽然抗病毒治疗是主要的治疗方法，但皮质类固醇的作用仍不明确。我们报告一例30岁男性病例，该患者在感染人类免疫缺陷病毒/获得性免疫缺陷综合征（HIV/AIDS）的情况下，出现进行性不对称下肢无力、便秘和尿潴留，且无皮节皮疹。磁共振成像（MRI）显示纵向广泛横贯性脊髓炎，脑脊液（CSF）分析证实VZV再激活。该患者接受了更昔洛韦和大剂量皮质类固醇治疗，初期神经功能有所改善。该病例突出了辅助性皮质类固醇治疗在减轻VZV脊髓炎炎症和改善预后方面的潜在益处。鉴于缺乏标准化治疗指南，需要进一步研究以阐明皮质类固醇的作用，并优化针对这种疾病的管理策略。
