VZV-related myelitis: a pathophysiological hypothesis
Outteryck, O.; Deramecourt, V.; Bombois, S.; Mackowiak-Cordoliani, M.A.; Pasquier, F.
Revue Neurologique (Paris) 163(1): 89-92
2007
ISSN/ISBN: 0035-3787 PMID: 17304177 Document Number: 605984
Introduction. Complications of VZV infection in the central nervous system are multiple. VZV-related myelitis is an uncommon complication of herpes zoster. Observation. We report the case of a 55-year old man with intercostal herpes zoster who presented a subacute medullar syndrome. MRI demonstrated an extended cervico-thoracic medullar hyperintensity on the T2-weighted images. Cerebrospinal fluid (CSF) analysis showed 100 leukocytes/mm(3), 0.94 g/L protein, negative VZV PCR, elevated rate of anti-VZV IgG and no oligocional bands. Clinical, biological and radiological presentations were compatible with the diagnosis of VZV-related myelitis with three potential pathophysiological mechanisms: infectious, immune post-infectious, vascular. The course was partially favorable after a 3-day regimen of corlicosteroid and 3 weeks of acyclovir infusions. Discussion. Parainfectious myelitis is often the consequence of a viral infection with a post-infectious pathogenesis. Most often, the clinical outcome is good. In this case report, we highlight the VZV vascular tropism and its more severe outcome. Conclusion. VZV-related myelitis should be diagnosed early. The combination of aciclovir and corticoids infusions seems to be beneficial.