The Korean Journal of Pain

The Korean Pain Society (대한통증학회)
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Herpes Zoster Meningitis Confirmed by Detection of Varicella-Zoster Virus DNA Using the Polymerase Chain Reaction -A case report-

중합효소 연쇄반응을 이용한 Varicella-Zoster Virus DNA 검출로 확인된 대상포진 수막염 -증례 보고-

  • Heo, Hu Man (Department of Anesthesiology Pain Medicine, Sanbon Hospital, Wonkwang University) ;
  • Choi, Yu Sun (Department of Anesthesiology Pain Medicine, Sanbon Hospital, Wonkwang University) ;
  • Park, Seong Kyu (Department of Orthopaedic Surgery, Sanbon Hospital, Wonkwang University)
  • 허후만 (원광대학교 의과대학 산본병원 마취통증의학교실) ;
  • 최유선 (원광대학교 의과대학 산본병원 마취통증의학교실) ;
  • 박성규 (원광대학교 의과대학 산본병원 정형외과학교실)
  • Received : 2005.03.25
  • Accepted : 2005.07.29
  • Published : 2005.12.10
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Abstract

Acute viral meningitis and myositis are rare complications of varicella-zoster virus (VZV) reactivation. A 71-years-old immunocompetent man, who presented with lower back pain radiating to the left lower extremities, developed vesicles on the L5 dermatomal area. The next day, he had complained of aberrant vesicles on the trunk, face and scalp, with generalized myalgia, headache and dizziness. He was confirmed with VZV meningitis and myositis, as demonstrated by the presence of VZV DNA in the blood and cerebral spinal fluid using a polymerase chain reaction (PCR) amplification. PCR has been used in patients with a VZV infection associated neurological symptoms, and provides a useful tool for the early diagnosis of VZV-associated neurological disease. The patient was treated with bed rest, with intravenous acyclovir for the VZV infection, and intravenous Patient-controlled Analgesia for pain management and the prevention of postherpetic neuralgia. When he visited the outpatient department 3 months later, the skin lesion, leg pain, headache and myalgia had all improved, without sequelae. Here, this case is reported, with a discussion of the relevant literature on its diagnosis and management.

Keywords

References

  1. Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ: Neurologic complications of the reacrivation of varicella-zoster virus. N Engl J Med 2000; 342: 635-45.
  2. Han KR, Kwak NK, Kim SM, Min KS, Kim C, Kim SM: Herpes zoster infection involved in cervical and thoracic spinal segment bilaterally. Korean J Pain 1999; 12: 144-7.
  3. Lee DK, Kwak KH, Do JH, Oh HJ: Herpes zoster with multiple cranial and upper cervical nerves involvement. Korean J Neurology 1997; 15: 712-5.
  4. Stratman E: Visceral zoster as the presenting feature of disseminated herpes zoster. J Am Acad Dermarol 2002; 46: 771-4.
  5. Jhaveri R, Sankar R, Yazdani S, Cherry JD: Varicella-zoster virus: an overlooked cause of aseptic meningitis. Pediatr Infect Dis J 2003; 22: 96-7.
  6. Klcinschmidr-DeMasrcrs BK, Gilden DH: Varicella-zoster virus infections of the nervous system: clinical and pathologic correlates. Arch Parhol Lab Med 2001; 125: 770-80.
  7. Echevarria JM, Casas 1, Martinez-Martin P: Infections of the nervous system caused by varicella-zoster virus: a review. Intervirology 1997; 40: 72-84.
  8. Steiner I, Stciner-Birmanns B, Levin N, Hershko K, Korn-Lubetzki I, Biran I: Spinal cord involvement in uncomplicated herpes zoster. Clin Diagn Lab Immunol 2001; 8: 850-1.
  9. Kim SK, Lee SH, Choi YC, Choi IS, Kim JH: Neurologic complications of herpes zoster. Korean J Neurology 1994; 12: 715-22.
  10. Cohen JI, Brunell PA, Straus SE, Krause PR: Recent advances in varicella-zoster virus infection. Ann Intern Med 1999; 130: 922-32.
  11. Boivin G: Diagnosis of herpesvirus infections of the central nervous system. Herpes 2004; 11: 48A- 56A.
  12. Calvario A, Bozzi A, Scarasciulli M, Ventola C, Seccia R, Sromari 0, et al: Herpes consensus PCR test: a useful diagnostic approach to the screening of vital diseases of the central nervous system. J Clin Virol 2002; 20: S71-S8.
  13. De La Blanchardiere A, Rozcnberg F, Caumes E, Picard 0, Lionner F, Livartowski J, et al: Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection. Scand J Infect Dis 2000; 32: 263-9.
  14. Yoon KB: Trearrnenr of herpes zoster: Nerve block. Korean J Pain 2004; 17: 17-21.
  15. Kim HK, Kim IS: The management of herpes zoster and post-herpetic neuralgia. Korean J Pain 1989; 2: 129-34.
  16. Gross G, Schofer H, Wassilew S, Friese K, Timm A, Guthoff R, et al: Herpes zoster guideline of Getman Dermatology Society (DOG). J Clin Virol 2003; 26: 277-89.
  17. Lee OK, Do JK, Kwak KH, Oh HJ: Three cases of acute aseptic meningitis followed by herpes zoster. Korean J Neurology 1996; 14: 1047-50.