Varicella zoster vasculopathy presenting as bilateral subdural haematoma in an infant: case report of a rare case and literature review.
Manish Joseph Mathew, Mukul Acharya, Enitan D Carrol et al.
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Case in brief
A 6-month-old boy developed chickenpox with fever, irritability, and a vesicular rash. Although the rash and fever resolved, he had persistent irritability, poor feeding, intermittent vomiting, developmental regression, and weight loss. Imaging at 7 months showed bilateral subdural collections resembling those associated with non-accidental injury. The collections recurred after aspiration and burr-hole evacuation, ultimately requiring a right subduro-peritoneal shunt. Subdural fluid was positive for VZV IgG, indicating previous VZV CNS encephalitis or vasculitis. On follow-up, he recovered, regained weight, and regained developmental milestones.
What made this case unusual
The delayed bilateral subdural haematomas after VZV infection mimicked findings associated with non-accidental injury; VZV IgG in the subdural fluid supported prior CNS involvement.
Diagnostic / clinical pearl
Persistent neurological symptoms after infant VZV infection warrant investigation for intracranial complications, including subdural collections that may resemble non-accidental injury.