[Myelitis associated with varicella-zoster virus in the absence of cutaneous zoster].

INTRODUCTION

The spectrum of neurological complications associated with the infection by varicella-zoster virus (VVZ) is very broad. The diagnosis, usually based on clinical findings and their temporal relationship with cutaneous herpes zoster should be confirmed by serological and/or virological techniques. However, there are an increasing number of cases compatible with this diagnosis in the absence of a skin rash.

CLINICAL CASE

We describe the case of a previously healthy woman of 27 who developed a neurological condition of subacute-chronic course, not preceded by a skin rash and compatible with the diagnosis of myelitis. She had had varicella at the age of 13. The MR of the medulla showed two hyperintense lesions in potentiated sequences in T2 at the level of the cervical medulla (segments C3-C4 and C6). Studies made to rule out other causes of myelopathy were normal or negative. After the first lumbar puncture there was an increase in the number of cells seen (up to 50/mm3) mainly mononuclear with oligoclonal bands, raised tibling index, antibodies (ab) IgG to VVZ and the indexes showing specificity to these abs and their intrathecal production were positive. Treatment with acyclovir produced no change in either her clinical condition or in the cerebrospinal fluid findings.

CONCLUSION

One should consider the possibility of the association with VVZ in patients of any age, whether immunodeficient or not, who present any neurological syndrome for which no other aetiology has been found, whether or not it is preceded by a typical skin rash. The improvement of serological and virological methods permits precise diagnosis of the disorder.