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Upreti G, Rathod K. Zoster Polyneuritis Cranialis and Intracranial Vasculopathy. Indian J Otolaryngol Head Neck Surg 2023; 75:971-974. [PMID: 37275114 PMCID: PMC10235217 DOI: 10.1007/s12070-022-03235-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 10/11/2022] [Indexed: 11/08/2022] Open
Abstract
A case report of varicella zoster virus (VZV) producing cranial polyneuropathy with intracranial vasculopathy afflicting the internal carotid artery, in a 45-year lady is presented. The clinical features included appearance of zosteriform rash in the left external auditory canal and concha, affliction of ophthalmic and maxillary divisions of V, VI, VII, VIII, IX and X cranial nerves. Contrast MRI brain demonstrated attenuated flow void in the left internal carotid artery. The diagnosis was confirmed with raised level of IgG VZV antibody in serum and detection of VZV IgG antibody in CSF, although PCR for VZV DNA in CSF was negative. The significance lies in atypical presentation, the diagnostic dilemma it poses, poor prognosis of cranial nerve function and the need for multidisciplinary approach to patient management and rehabilitation.
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Affiliation(s)
- Garima Upreti
- Department of Otorhinolaryngology and Head-Neck Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat India
- Present Address: Department of Otorhinolaryngology and Head-Neck Surgery, All India Institute of Medical Sciences, Rajkot, Gujarat India
| | - Khevna Rathod
- Department of Otorhinolaryngology and Head-Neck Surgery, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat India
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Jung JW, Jang YJ, Hong EH, Kim KH, Kim KJ, Park EJ. Dysphagia with Unilateral Vocal Cord Paralysis in Herpes Zoster: A Case Report. Ann Dermatol 2022; 34:475-477. [PMID: 36478430 PMCID: PMC9763904 DOI: 10.5021/ad.20.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 01/19/2021] [Accepted: 02/01/2021] [Indexed: 11/25/2022] Open
Abstract
Herpes zoster is caused by the varicella-zoster virus, which becomes latent in ganglia after primary infection. When the varicella-zoster virus reactivates on the cranial nerve, the patient can suffer from cranial nerve palsy, pain, and skin lesions on the head and neck area. A 57-year-old immunocompetent male presented with dysphagia lasting 10 days. Computed tomography and other neurological findings were normal. However, laryngoscopy showed right vocal cord paralysis, which might be the reason for dysphagia in this patient. There was a grouped crusted lesion on the right posterior auricular area that appeared 5 days after the dysphagia. After famciclovir and prednisolone combination therapy, the patient was cured with no sequelae. This is a rare case of herpes zoster in an immunocompetent patient who presented with dysphagia. In addition, it was difficult to make an accurate diagnosis because his skin lesion appeared several days after dysphagia.
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Affiliation(s)
- Joon Woo Jung
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ye Ji Jang
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Hye Hong
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Ho Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Kwang Joong Kim
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Eun Joo Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, Anyang, Korea
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3
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Lee YW, Yoo B, Lim YH. Varicella-zoster virus meningitis after spinal anesthesia: A case report. World J Clin Cases 2022; 10:9127-9131. [PMID: 36157639 PMCID: PMC9477043 DOI: 10.12998/wjcc.v10.i25.9127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 06/27/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Headache is a common complication of regional anesthesia. The treatment of post spinal anesthesia headache varies depending on the cause. Although meningitis is rare, it can cause significant harm to the patient. Post dural puncture headache and septic meningitis are the most commonly suspected causes of post spinal anesthesia headache; however, other causes should also be considered.
CASE SUMMARY A 69-year-old woman was scheduled for varicose vein stripping surgery under spinal anesthesia. The procedure was performed aseptically, and surgery was completed without any complications. After 4 d, the patient visited the emergency room with complaints of headache, nausea, and anorexia. Clinical examination revealed that the patient was afebrile. Considering the history of spinal anesthesia, post dural puncture headache and septic meningitis was initially suspected, and the patient was treated with empirical antibiotics. Subsequently, varicella-zoster virus PCR test result was positive, and all other test results were negative. The patient was diagnosed with meningitis caused by varicella-zoster virus and was treated with acyclovir for 5 d. The headache improved, and the patient was discharged without any problems.
CONCLUSION Viral meningitis due to virus reactivation may cause headache after regional anesthesia. Therefore, clinicians should consider multiple etiologies of headache.
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Affiliation(s)
- Ye-Won Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul 01757, South Korea
| | - Byunghoon Yoo
- Department of Anesthesiology and Pain Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul 01757, South Korea
| | - Yun Hee Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Inje University, Sanggye Paik Hospital, Seoul 01757, South Korea
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Sonneville R, Jaquet P, Vellieux G, de Montmollin E, Visseaux B. Intensive care management of patients with viral encephalitis. Rev Neurol (Paris) 2021; 178:48-56. [PMID: 34973832 DOI: 10.1016/j.neurol.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/13/2021] [Indexed: 11/26/2022]
Abstract
Viral encephalitis is a severe syndrome that can lead to encephalopathy, seizures, focal deficits, and neurological sequelae and death. It is mainly caused by neurotropic herpes viruses (i.e., HSV and VZV), although other pathogens may be observed in specific geographic regions or conditions. Recent advances in neuroimaging and molecular biology (PCR, metagenomics) allow for faster and more accurate etiological diagnoses, although their benefits need to be confirmed to provide guidelines for their use and interpretation. Despite intravenous acyclovir therapy and supportive care, outcomes remain poor in about two-thirds of herpes encephalitis patients requiring ICU admission. Randomized clinical trials focusing on symptomatic measures (i.e. early ICU admission, fever control, and treatment of seizures/status epilepticus) or adjunctive immunomodulatory therapies (i.e. steroids, intravenous immunoglobulins) to improve neurologic outcomes have not been conducted in the ICU setting. Large prospective multicenter studies combining clinical, electrophysiological, and neuroimaging data are needed to improve current knowledge on care pathways, long-term outcomes, and prognostication.
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Affiliation(s)
- R Sonneville
- Université de Paris, INSERM UMR1148, team 6, 75018 Paris, France; AP-HP, intensive care medicine, Hôpital Bichat - Claude Bernard, 75018 Paris, France.
| | - P Jaquet
- AP-HP, intensive care medicine, Hôpital Bichat - Claude Bernard, 75018 Paris, France
| | - G Vellieux
- AP-HP, department of Physiology, Hôpital Bichat - Claude Bernard, 75018 Paris, France
| | - E de Montmollin
- Université de Paris, INSERM UMR1148, team 6, 75018 Paris, France; Université de Paris, INSERM UMR1137, team 6, 75018 Paris, France
| | - B Visseaux
- Université de Paris, INSERM UMR1137, team 6, 75018 Paris, France; AP-HP, department of virology, Hôpital Bichat - Claude Bernard, 75018 Paris, France
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Abreu E Silva HBD, Corrêa HP, Ribeiro IA, Nascimento VAM, Greco CM, Pinto ICT, Teixeira DC, Diniz LMO, Ribeiro JGL. Impact of six years of routine varicella vaccination on the disease-related hospitalizations at Minas Gerais, Brazil. Vaccine 2021; 40:390-395. [PMID: 34507860 DOI: 10.1016/j.vaccine.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/07/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The varicella vaccine was first introduced into the Brazilian immunization schedule in September 2013 as a single dose for children aged 15 months. In 2018, a second dose was recommended for individuals between 4 and 6 years old. This study aims to assess the impact of routine varicella vaccination on the number and profile of hospitalized varicella patients during the single dose period, as well as in the first two years after the adoption of the second dose. METHODS An observational retrospective study was conducted in an infectious disease pediatric hospital, in Minas Gerais, Brazil. Clinical as well as epidemiological data from patients hospitalized due to varicella between 2010 and 2019 were collected. Patients were split into groups based on the vaccine introduction: pre-vaccine period, single dose and two-dose period. They were compared by age, sex, reason for admission, illness-related complications and clinical outcome. RESULTS There were 1193 admissions due to varicella during the studied period. When compared with the pre-vaccine period, the number of hospitalizations decreased in 61.5% during the single-dose regime, reaching 95.2% in the two-dose period. Hospitalization rates decreased in all age groups, including non-vaccinated individuals such as those younger than 12 months (92.1%). As for reasons of admission, secondary bacterial skin infections were perceived to be the most common cause (>70%). A reduction was also seen in admission of immunocompromised or HIV positive patients (84.8%). CONCLUSION The collected data shows a significant impact in the number of hospital admissions due to varicella after six years of the implementation of the vaccine, positively affecting both vaccinated and non-vaccinated individuals. Further reduction was seen after the second dose was initiated, but its true impact will only be understood fully after a longer period of continuous vaccination.
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Au SCL. Herpes zoster ophthalmicus: The importance of face mask removal examination under the COVID-19 pandemic. Vis J Emerg Med 2021; 24:101083. [PMID: 34316521 PMCID: PMC8294878 DOI: 10.1016/j.visj.2021.101083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/01/2021] [Indexed: 06/13/2023]
Affiliation(s)
- Sunny Chi Lik Au
- Department of Ophthalmology, Tung Wah Eastern Hospital, Hong Kong
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Steinberg CJ, Moody AD, Yenior AL, Bertasi RAO, Kieneker L, Pujalte GGA. Disseminated herpes zoster with cauda equina symptoms. IDCases 2020; 21:e00902. [PMID: 32670796 PMCID: PMC7350134 DOI: 10.1016/j.idcr.2020.e00902] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 12/30/2022] Open
Abstract
Herpes zoster is a common infection resulting from the reactivation of dormant varicella zoster virus in a posterior dorsal root ganglion. The typical dermatomal involvement includes the thoracic region, followed by the face and the cervical and lumbosacral regions, with 1% having disseminated disease. We present a rare case of an immunocompetent 85-year-old man presenting with herpes zoster at the L3-S2 dermatomes, that evolved to disseminated varicella zoster virus (dVZV), with radiologically and laboratory-confirmed lumbosacral plexopathy manifesting with cauda equina syndrome. Here we also discuss the diagnosis and complications of dVZV as well as treatment strategy. By maintaining a high degree of clinical suspicion and initiating early treatment, high-quality patient care and good outcomes are able to be achieved in cases like this.
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Affiliation(s)
- Corey J Steinberg
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Austin D Moody
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - Ashley L Yenior
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
| | | | - Lisa Kieneker
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
| | - George G A Pujalte
- Department of Family Medicine, Mayo Clinic, Jacksonville, FL, United States
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Takada H, Kohara S, Ito T, Yoshioka H, Okada I, Kiriu N, Koido Y, Hasegawa E. Disseminated Varicella zoster infection with abdominal pain and periarterial fat stranding in a patient taking pomalidomide. Acute Med Surg 2020; 7:e494. [PMID: 33391765 PMCID: PMC7774293 DOI: 10.1002/ams2.494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/21/2020] [Accepted: 02/04/2020] [Indexed: 11/12/2022] Open
Abstract
Background Disseminated Varicella zoster virus infection (DVI) is a severe infection associated with severe abdominal pain of unknown cause. We report a case in which periarterial (the celiac artery and superior mesenteric artery) fat stranding (PFS) on computed tomography (CT) was the presumed cause of abdominal pain in a patient taking pomalidomide. Case Presentation A 62-year-old woman was admitted to our hospital with abdominal pain. Her medical history was multiple myeloma treated with pomalidomide. Computed tomography showed no remarkable findings on admission, but 1 day later, a contrast-enhanced CT showed PFS. A skin eruption appeared on day 4 and we started acyclovir. On day 10, Varicella zoster virus antigen and antibody tests were positive, confirming the diagnosis of DVI. The abdominal pain subsequently improved, together with the PFS, and she was discharged. Conclusion When patients present with severe abdominal pain and PFS, DVI and acyclovir must be considered.
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Affiliation(s)
- Hiroaki Takada
- Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Saeko Kohara
- Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Takashi Ito
- Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Hayato Yoshioka
- Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Ichiro Okada
- Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Nobuaki Kiriu
- Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Yuichi Koido
- Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
| | - Eijyu Hasegawa
- Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan
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Abstract
Infections in immunosuppressed patients represent a particular challenge in the diagnostics and treatment. They often present with atypical and particularly severe courses, for which rapid diagnostics and treatment are decisive for treatment success. Opportunistic infections with human herpes viruses occur not only more frequently in immunocompromised patients compared to healthy people but also represent a special challenge. In the treatment of immunosuppressed patients, e.g. with human immunodeficiency virus infections and patients with solid organ transplantations, infections with herpes simplex virus, varicella zoster virus, Epstein-Barr virus and cytomegalovirus are particularly important. The symtoms are very variable, ranging from asymptomatic detection of viremia to vital life-threatening organ manifestations. This review article describes the most important clinical presentations of these opportunistic infections. Furthermore, the diagnostic, therapeutic and prophylactic strategies for human herpes viruses are summarized.
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Affiliation(s)
- N Floß
- Klinik für Infektiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Deutschland
| | - S Dolff
- Klinik für Infektiologie, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstraße 55, 45122, Essen, Deutschland.
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Angstwurm K, Neumann B. [Infections of the central nervous system in immunodeficiency]. Internist (Berl) 2019; 60:690-700. [PMID: 31093686 DOI: 10.1007/s00108-019-0614-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Treatments in oncology, transplantation medicine and immunology frequently lead to immunodeficiency. This review presents the most important opportunistic neurologic infections, mostly of the central nervous system (CNS). Signs and symptoms, diagnostic procedures and therapeutic options are presented. The most frequent infections are due to varicella zoster virus (VZV), Cryptococcus neoformans and Toxoplasma gondii; JC virus (JCV) and cytomegalovirus (CMV) are rare causes of encephalitis. Differential diagnoses include infection by non-opportunistic causatives, therapy associated neurotoxicity, Epstein-Barr virus (EBV) associated CNS lymphoma, recurrence of the malignancy, as well as non-infectious diseases like intracranial bleeding, ischemic stroke, autoimmune diseases and posterior reversible leukencephalopathy syndrome. Treatment of these patients, moreover, needs to consider all previous therapies and to involve a neurologist.
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Alexander KE, Tong PL, Macartney K, Beresford R, Sheppeard V, Gupta M. Live zoster vaccination in an immunocompromised patient leading to death secondary to disseminated varicella zoster virus infection. Vaccine 2018; 36:3890-3. [PMID: 29807711 DOI: 10.1016/j.vaccine.2018.05.078] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/27/2018] [Accepted: 05/21/2018] [Indexed: 01/18/2023]
Abstract
In 2016, the live attenuated zoster vaccine (Zostavax, Merck and Co, USA) was introduced into the Australian National Immunisation Program for people aged 70 years who are not significantly immunocompromised. We report the administration of Zostavax in an immunocompromised patient with chronic lymphocytic leukaemia and no evidence of primary varicella zoster virus (VZV) infection. The patient presented with a bilateral vesicular facial rash 22 days after receiving Zostavax and was initially managed as an outpatient with oral acyclovir. He re-presented three days later and was diagnosed with disseminated VZV infection complicated by meningoencephalitis. The patient died following cardiac arrest on day 10 of hospitalisation. This unfortunate case highlights the challenge of safely implementing a high titre live vaccine in a population where contraindications are prevalent. The non-live recombinant herpes zoster subunit vaccine (Shingrix, GSK) may provide a safe and effective option to protect immunocompromised patients from shingles and post-herpetic neuralgia.
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