Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Varicella-zoster virus-associated polyradiculoneuritis with concomitant herpes zoster eruption: a case report

Hiroshi Shoji, M.D.1), Yoshihisa Fukushima, M.D.2), Yoritake Sakoda, M.D.3), Toshifumi Abe, M.D.4), Shuichi Oguri, M.D.5) and Masayuki Baba, M.D.6)

1)Departments of Neurology, St. Mary's Hospital
2)Departments of Cerebrovascular Medicine, St. Mary's Hospital
3)Departments of Respiratory, St. Mary's Hospital
4)Departments of Dermatology, St. Mary's Hospital
5)Departments of Radiology, St. Mary's Hospital
6)Department of Neurology, Aomori Prefectural Central Hospital

A 76-year-old Japanese female who was treated with long-term use of prednisolone at 10 mg/day for interstitial pneumonia developed acute right-dominant lower limb paralysis and then upper limb paralysis with herpes zoster eruptions on the right C7-Th1 dermatomes. On admission, right predominant quadriplegia was observed with sensory symptoms; Hughes functional grade was level 4; the hand grip power was right, 0, and left, 7 kg, the deep tendon reflexes were abolished throughout without pathologic reflexes. Twenty days after the onset of the symptoms, the cerebrospinal fluid (CSF) revealed mild increases of lymphocytes (13 cells/μl) and protein content (73 mg/dl). Varicellazoster virus (VZV) PCR was negative in the CSF, but an enzyme immunoassay for VZV was positive in her serum and CSF, and the high titers were prolonged. Peripheral nerve conduction and F wave studies suggested right-dominant demyelinating polyradiculoneuropathy. A T1-weighted MR contrast image exhibited right-dominant high-intensity lesions on the C7-Th1 spinal roots and similar lesions on the L4-5 spinal roots. We compared with several similar cases from the literature and proposed that VZV itself involves the pathogenesis of the polyradiculoneuritis in immunocompromised hosts.
Full Text of this Article in PDF (1202K)

(CLINICA NEUROL, 59: 641|645, 2019)
key words: herpes zoster, varicella-zoster virus, Guillain-Barré syndrome, polyradiculoneuritis

(Received: 19-May-19)