Varicella zoster virus meningitis with a dermatomal rash in immunocompetent hosts: a systematic review and novel case report.
Nathaniel B Dusseau, Aizaz Ali, Ahmed Ba Theeb et al.
✦ AI-curated · Sources linked
Case in brief
A 44-year-old immunocompetent man presented with fever, severe headache, and a right-sided vesicular rash in the C4-C5 dermatomes. He was initially misdiagnosed with a tick-borne illness. The report identifies the illness as VZV meningitis; across the reviewed cases, mean CSF WBC count was 382/µL (SD ± 270), protein 177 mg/dL (SD ± 106), and glucose 52.7 mg/dL (SD ± 15.8). All 17 patients survived and recovered fully. IV acyclovir was used in 15 cases, with oral acyclovir or valacyclovir commonly used as step-down therapy.
What made this case unusual
The patient’s rash was confined to the C4-C5 dermatomes, an uncommon spinal-dermatomal presentation of VZV meningitis in an immunocompetent adult, and initially led to a tick-borne illness diagnosis.
Diagnostic / clinical pearl
VZV meningitis can accompany a spinal dermatomal rash, including cervical involvement, in immunocompetent adults; consider the rash pattern and use timely PCR testing to support diagnosis.