Cerebral Hemorrhage in Varicella-Zoster Virus Encephalitis: A Case Study

Abstract

BACKGROUND Varicella-zoster virus (VZV) encephalitis is a commonly reported form of encephalitis that clinically manifests as skin lesions, fever, headache, and neuropsychiatric symptoms. We present a case of a patient with VZV encephalitis complicated by cerebral hemorrhagic transformation, characterized by high levels of inflammation and protein in the cerebrospinal fluid. The aim is to highlight the risk of hemorrhagic transformation associated with VZV encephalitis. CASE REPORT The patient exhibited scattered herpes lesions on the head, neck, and chest. Notably, the cerebrospinal fluid (CSF) protein concentration was markedly elevated at 9049.3 mg/L, with a CSF white blood cell count of 950×10⁶/L, of which lymphocytes constituted 80%. MRI revealed abnormal signal foci in the bilateral temporal lobes and the right frontal lobe, consistent with findings associated with herpes encephalitis. Despite initial treatment with anti-inflammatory agents, acyclovir antiviral, and antiepileptic medications, the patient did not show improvement, prompting the addition of double filtration plasmapheresis. However, the patient experienced hemorrhagic transformation and succumbed to the illness. CONCLUSIONS This case highlights the challenge of managing VZV encephalitis in the context of significant inflammation and protein elevation in the CSF, and underscores the need for further research into more effective therapeutic strategies for this rare but potentially devastating condition.

Figure 1.

Electroencephalogram determination. The electroencephalogram showed mild-to-moderate diffuse abnormalities.

Figure 2.

Genome coverage map of varicella zoster virus. The total number of varicella-zoster virus sequences was 10 795, with a coverage of 94.08%.

Figure 3.

Head MRI images. T1-weighted images (A, C) revealed low-density lesions in the bilateral temporal and right frontal lobes. Fluid-attenuated inversion recovery (B, D) exhibited high-density lesions in the bilateral temporal and right frontal lobes. MRI – magnetic resonance imaging.

Figure 4.

CT images of the head. Axial head CT scans (A, B) revealed cerebral hemorrhage in the left frontal, parietal, and temporal lobes, as well as in the right frontal lobe, with extensions into the ventricular system. CT – computed tomography.