Harrington William B, Fugler Patrick, DeStefino Vincent
Graduate Medical Education, University of Pittsburgh Medical Center, Altoona, USA.
Emergency Medicine, University of Massachusetts Chan Medical School (UMASS) Baystate Health, Springfield, USA.
Cureus. 2025 Aug 3;17(8):e89299. doi: 10.7759/cureus.89299. eCollection 2025 Aug.
Varicella zoster virus (VZV) is a single-stranded enveloped RNA virus that is a common cause of chickenpox and herpes zoster. Herpes zoster (shingles) presents with a painful rash in a dermatomal distribution. Ramsay-Hunt syndrome (herpes zoster oticus) is a specific form of shingles, which occurs due to viral reactivation in the geniculate ganglion of cranial nerve VII. It can cause the triad of symptoms of ipsilateral facial paralysis, ear pain, and vesicles in the auditory canal or on the auricle. VZV is also a rare cause of aseptic meningitis, which occurs more commonly in immunodeficient rather than immunocompetent individuals. VZV meningitis can occur with or without the stereotypical rash, which may be very minimal if present. Here, we present a case of a 30-year-old immunocompetent man who presented to his local emergency department (ED) after failed treatment of otitis media and two syncopal events. ED evaluation was positive for nuchal rigidity, scalp tenderness, and an enlarged lymph node on his right posterior neck. PCR analysis was positive for VZV meningitis without overt rash. His only skin finding was erythematous patches in the right auditory canal with a bulging tympanic membrane. His auditory symptoms did not improve with adequate antibiotic treatment, meaning his symptoms were likely viral in nature. The treating infectious disease physician felt his auditory symptoms were related to his VZV infection; however, no confirmatory tests were completed. He was discharged on hospital day 4 and completed a total of 14 days of acyclovir 500mg three times a day. Additionally, we discuss the implications of intravenous acyclovir therapy in mild VZV meningitis in young immunocompetent individuals and the role oral valacyclovir therapy can play.
水痘带状疱疹病毒（VZV）是一种单链包膜RNA病毒，是水痘和带状疱疹的常见病因。带状疱疹表现为沿皮节分布的疼痛性皮疹。拉姆齐-亨特综合征（耳带状疱疹）是带状疱疹的一种特殊形式，由颅神经VII膝状神经节中的病毒再激活引起。它可导致同侧面部麻痹、耳痛以及耳道或耳廓出现水疱这一组三联征症状。VZV也是无菌性脑膜炎的罕见病因，在免疫功能低下而非免疫功能正常的个体中更常见。VZV脑膜炎可伴有或不伴有典型皮疹，若有皮疹可能非常轻微。在此，我们报告一例30岁免疫功能正常的男性病例，该患者在中耳炎治疗失败及两次晕厥事件后前往当地急诊科就诊。急诊科评估发现其存在颈项强直、头皮压痛以及右后颈部淋巴结肿大。PCR分析显示VZV脑膜炎阳性但无明显皮疹。他唯一的皮肤表现是右耳道有红斑伴鼓膜膨出。给予充分的抗生素治疗后他的耳部症状未改善，这意味着他的症状可能本质上是病毒性的。主治传染病医生认为他的耳部症状与VZV感染有关；然而，未完成确诊检查。他在住院第4天出院，总共服用了14天的阿昔洛韦，每日三次，每次500毫克。此外，我们讨论了静脉注射阿昔洛韦疗法对年轻免疫功能正常个体的轻度VZV脑膜炎的影响以及口服伐昔洛韦疗法可发挥的作用。
