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Table 1 Reported cases of encephalitis caused by varicella zoster virus reactivation in immunocompetent children

From: Encephalitis due to herpes zoster without rash in an immunocompetent 12-year-old girl: case report and review of the literature

 

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 (4 years)

Chickenpox (NA)

Previous reactivation

No

Zoster (10 years)

No

Clinical presentation:

   

-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:

   

- 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