A Case of Transverse Myelitis Caused by Varicella Zoster Virus in an Immunocompetent Older Patient

Abstract

Varicella zoster virus (VZV) is a human neurotropic alphaherpesvirus that causes chickenpox (varicella) in children. VZV reactivation may lead to neurological complications, including transverse myelitis. However, transverse myelitis caused by VZV reactivation is rare in immunocompetent patients. Herein, we report a case of transverse myelitis caused by VZV in an immunocompetent older patient, and confirmed this case by polymerase chain reaction. A 79-year-old woman visited our service with complaints of weakness in the right lower leg, generalized vesicular eruptions, and throbbing pain in the right flank for ten days. Spine MRI showed transverse myelitis in the thoracic spine at level T4-T11. The patient was treated with acyclovir and her neurological functions improved, except for sensory impairment below level T10. For older patients, early and aggressive antiviral treatment against VZV may be necessary even though these patients are immunocompetent.

Keywords: Antiviral treatment; Immunocompetent; Older patients; Transverse myelitis; Varicella zoster virus.

Figure 1

Development of multiple vesicles and pustules in the right flank (A) and their spread to the trunk (B).

Figure 2

Whole spine MRI (T2-weighted sagittal image) on admission (A) shows high-signal intensity from level T4 (upper arrow) to T11 (lower arrow). On admission day 36 (B), the extent of diffuse hyperintensity decreased, with faint enhancement of the spinal cord from level T8–T9 (upper arrow) to T9 (lower arrow).