| Chiappini et al., 2002 [11] | Spiegel et al., 2010 [12] | Our patient, 2020 |
---|---|---|---|
Age and gender | 2-year-old boy | 14-year-old girl | 12-year-old girl |
Chickenpox/vaccination (age) | Chickenpox (4 months) | Chickenpox (4Â years) | Chickenpox (NA) |
Previous reactivation | No | Zoster (10Â years) | No |
Clinical presentation: | Â | Â | Â |
-Fever | Yes (T 38.5 °C) | Yes (T 39.2 °C) | Yes (T 38 °C) |
-Neurological symptoms & signs | Frontal headache, vomiting, disturbed consciousness, miotic pupils, tendon reflexes absent, left ankle clonus, bilateral Babinski’s reflexes elicited | Paresthesias and hyperesthesia at left limbs, proximal left leg weakness; severe frontal and occipital headache, stiff neck, positive Brudjinski sign | Severe frontal headache, vomiting, photophobia, altered mental status, psychomotor agitation. |
- Skin rash | No | No | No |
CSF: | Â | Â | Â |
- white cells/mL | Normal | 434 | 484 |
- protein (mg/dL) | Normal | 59 | 72 |
- glucose (mg/dL) | Normal | 49 | 52 |
- PCR for VZV-DNA | Positive | Positive | Positive |
IgG and IgM VZV | Serum: IgG +, IgM - CSF: IgG and IgM - | Serum: IgG +, IgM - | Serum: IgG +, IgM - |
EEG | Findings compatible with viral encephalitis | Right-hand sided slow waves, compatible with right hemisphere encephalopathy | Severe alteration of cortical electrogenesis with exacerbation of diffuse slow cortical activity, with fronto-temporal predominance |
MRI | Bilateral multifocal changes in white and gray matter, predominantly on the fronto–parietal cortex | 4 hyperintense lesions without enhancement after gadolinium injection: 1 in right thalamus, 1 in right temporal subcortical region, 2 in right parietal subcortical region | Unremarkable |
Immunological screening | HIV Ab negative; IgG, IgA, IgM serum levels, B and T-lymphocyte counts, NK cell subset counts, in vitro T-lymphocyte response to mitogens, MHC I and II class molecule-positive cell counts: normal. | HIV Ab negative; IgG, IgA, IgM serum levels, complement studies, total counts and functional studies of T cells: normal. | HIV Ab negative; IgG, IgA, IgM serum levels, B and T-lymphocyte counts |
Treatment (days) | Acyclovir iv (15 days); ceftriaxone iv (5 days) | Acyclovir iv (14 days); methylprednisolone iv (5 days) | Acyclovir iv (14 days) followed by oral acyclovir (14 days) |
Sequelae | Mild right hemiparesis | Left thigh neuralgia | No |