Encephalitis of varizella-zoster in a 26 months old child

Aims: Primary varizella-zoster infections relate usually to immundeficient children. Histopathologic it concerns a vasculitis of the small vessels (most immundefecient, VZV-PCR positive in the CSF) or the big vessels (most immuncompetent, VZV- Antigen positive, VZV- PCR negativ in the CSF). The diagnosis depends on the clinic, the MRI and the PCR of the VZV- DNS in the CSF. Here, we present the dramatic case of a young boy in whom a typical infection of varizella-zoster led to an encephalitis of varizella- zoster.

Diagnosis, therapy and course: A previously healthy 26 months old children was admitted to our hospital due to complicated seizure of fever. The lumbalpunction delivered cells in the CSF and a positive PCR of VZV. MRI showed in the T2 high signal intense lesions subgyral, parietal and temporal right and in the area oft the Inselrinde left. Despite therapy with acyclovir the clinical condition made worse with somnolenz, dysarthria, ataxia and intentionstremor. At this time analysis of CSF showed while treating with acyclovir a clear dropping cell count and a negativ VZV- PCR. We treated for a total duration of 14 days. The treatment with glukokortikoids is not confirmed, we decided against glukokortikoids. Thereafter the boy continuously improved and slowly regained his lost motor functions. Four weeks after hospitalisation and a rehabilitation about 3 weeks the ataxia is completely dropping. In the Mental scale he achieved 90 which corresponded to his age. However a diskret inversionsdystonia of his right leg still remained.

Conclusion: Encephalitis associated with HHV is one o the heaviest neurological diseases. Primary VZV infection can cause an encephalitis. Important is the treatment with acyclovir intravenous for at least 14 days to prevent early relapses.