Herpes Zoster with Acute Encephalomyelitis : A Case Report

<p>An 80-year-old woman without immune deficiency visited her local clinic for skin eruptions on her right upper limb and right back. The patient wasdiagnosed with herpeszoster and wastreated using famciclovir. However, she had anorexia and malaise 3 days after taking her medication. There was no fever or unconsciousness. Erythema and vesicles were scattered in the C4 and C5 areasfrom the right shoulder to the upper arm, and in the Th10 area of the right lumbar region. The patient wasdiagnosed with multidermatomal herpeszoster and intravenousacyclovir wasstarted on admission. Eruptions were crusted, but general malaise did not improve. Right hemiplegia and thermal pain sensation below C3 on both sides developed. The number of cells in the cerebrospinal fluid increased. Cervical spine enhanced MRI demonstrated a high-signal area extending from the brainstem medulla to the C3-4 level of her cervical spine. The patient was diagnosed with encephalomyelitis due to varicella-zoster virus, and was treated using a double dose of acyclovir for 7 days and 3 courses of steroid pulse therapy. Muscle weakness and thermal pain sensation improved. However, as enhanced MRI revealed enhancement of the lesion, a double dose of acyclovir was readministered with one course of steroid pulse therapy. The patient was transferred to rehabilitation after a total of 34 daysof acyclovir. Currently, rehabilitation for difficulty in raising her right upper limb and contracture of her right shoulder is continuing. Varicella-zoster virus myelitismay develop without an underlying disorder that causesimmune decline. Asmotor paresis due to myelitishasa poor neurological prognosis, a careful explanation of the condition isrequired. Skin Research, 19 : 111-116, 2020 </p>