PMID- 32280573
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20200928
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 12
IP  - 3
DP  - 2020 Mar 10
TI  - Zoster Sine Herpete Masquerading as Central Nervous System Vasculitis.
PG  - e7231
LID - 10.7759/cureus.7231 [doi]
LID - e7231
AB  - Central nervous system (CNS) vasculopathy caused by varicella zoster virus (VZV) 
      is a rare condition. Rarer still is the development of CNS vasculopathy in the 
      absence of a typical zoster rash, a phenomenon known as zoster sine herpete. We 
      report a case of a 34-year-old male with HIV, non-compliant with highly active 
      antiretroviral therapy (HAART), who presented with left-sided temporal headaches 
      and numbness without rash. The patient had a complicated one-month hospital stay 
      when he was initially diagnosed with mycobacterium avium complex (MAC) 
      tuberculosis infection and treated with isoniazid, rifabutin, ethambutol, and 
      azithromycin. Additionally, he was thought to have immune reconstitution 
      inflammatory syndrome (IRIS) and was given steroids. Unfortunately, he presented 
      one day post-discharge with lethargy, aphasia, and dysphagia and was found to 
      have acute/subacute infarcts affecting multiple areas of the brain. CT angiogram 
      (CTA) of the brain showed evidence of multifocal areas of mild to moderate 
      stenosis throughout the intracranial arterial circulation. The patient underwent 
      conventional angiography, which showed segmental arterial constrictions with 
      post-stenotic dilatation consistent with vasculitis. Cerebrospinal fluid (CSF) 
      studies eventually returned positive for VZV by polymerase chain reaction (PCR), 
      confirming a diagnosis of VZV-induced CNS vasculopathy, or more specifically, CNS 
      vasculopathy due to zoster sine herpete. The patient was treated with high-dose 
      steroids as well as IV acyclovir with improvement in his symptoms. He was 
      discharged with advice for a close follow-up with the infectious disease (ID) 
      department. Our case highlights the importance of maintaining a high index of 
      suspicion for varicella infection masquerading as CNS vasculitis, particularly in 
      the absence of classic blistering shingles rash. Early detection may prevent 
      neurological sequelae of the infection, including stroke, dissection, or 
      neuropathy.
CI  - Copyright (c) 2020, Lau et al.
FAU - Lau, Arthur
AU  - Lau A
AD  - Rheumatology, Temple University Hospital, Philadelphia, USA.
FAU - Essien, Eno-Obong
AU  - Essien EO
AD  - Internal Medicine, Temple University Hospital, Philadelphia, USA.
FAU - Tan, Irene J
AU  - Tan IJ
AD  - Rheumatology, Einstein Medical Center, Philadelphia, USA.
LA  - eng
PT  - Case Reports
DEP - 20200310
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC7145380
OTO - NOTNLM
OT  - cns vasculitis
OT  - hiv
OT  - immunocompromised
OT  - shingles
OT  - varicella zoster virus
OT  - vasculitis
OT  - vasculopathy
OT  - zoster sine herpete
COIS- The authors have declared that no competing interests exist.
EDAT- 2020/04/14 06:00
MHDA- 2020/04/14 06:01
PMCR- 2020/03/10
CRDT- 2020/04/14 06:00
PHST- 2020/04/14 06:00 [entrez]
PHST- 2020/04/14 06:00 [pubmed]
PHST- 2020/04/14 06:01 [medline]
PHST- 2020/03/10 00:00 [pmc-release]
AID - 10.7759/cureus.7231 [doi]
PST - epublish
SO  - Cureus. 2020 Mar 10;12(3):e7231. doi: 10.7759/cureus.7231.