SHM Converge Scientific Abstract ePoster Gallery-A Case Report of Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated With Disseminated Varicella-Zoster Virus Infection in an Immunocompetent Adult

A Case Report of Syndrome of Inappropriate Antidiuretic Hormone Secretion Associated With Disseminated Varicella-Zoster Virus Infection in an Immunocompetent Adult

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This case report describes a 62-year-old man with diabetes who presented with altered mental status and urinary frequency. Initial evaluation showed hypotonic hyponatremia consistent with SIADH: serum sodium 125 mmol/L, low serum osmolality, and inappropriately concentrated urine with high urine sodium. Brain CT and MRI showed no acute structural cause, so he was treated with hypertonic saline, oral urea, a loop diuretic, and fluid restriction.<br /><br />During hospitalization, he developed characteristic vesicular skin lesions on the back and right flank. Skin swab PCR confirmed varicella-zoster virus (VZV), and serology suggested reactivation rather than primary infection. He was started on intravenous acyclovir. Further neurologic workup revealed cerebrospinal fluid pleocytosis and elevated protein, and CSF PCR was positive for VZV, establishing disseminated VZV infection with encephalitis.<br /><br />The patient improved clinically with antiviral therapy. His mental status returned to baseline, serum sodium normalized, and a repeat lumbar puncture after 14 days of acyclovir was negative for VZV. He was discharged in stable condition with full neurologic recovery.<br /><br />The report highlights a rare but recognized association between VZV infection and SIADH. The proposed mechanism is not fully understood, but VZV may disrupt osmoreceptor pathways connected through dorsal root ganglia, leading to abnormal antidiuretic hormone secretion. In this case, the simultaneous resolution of SIADH and VZV infection, along with lack of another identifiable cause, supports the link.<br /><br />Overall, the case emphasizes the need to consider SIADH in patients with VZV infection, especially when hyponatremia and neurologic symptoms are present, so treatment can be started promptly and complications avoided.

Asset Subtitle

Shawn Owiredu

Meta Tag

Author List Charbel Nakhoul, Kevin d'Mello, Shawn Owiredu

Category Clinical Vignettes

Concept Varicella-Zoster Virus

Concept Syndrome of Inappropriate Antidiuretic Hormone Secretion

Concept Encephalitis

Concept Hyponatremia

Concept Acyclovir

Distinguished Non-Finalist

Presenter Organization Cooper University Healthcare

Presenting Author Shawn Owiredu

Track Adult

Keywords

varicella-zoster virus

SIADH

hyponatremia

encephalitis

disseminated VZV infection

altered mental status

urinary frequency

cerebrospinal fluid pleocytosis

acyclovir

fluid restriction

Varicella-Zoster Virus

Syndrome of Inappropriate Antidiuretic Hormone Secretion

Encephalitis

Hyponatremia

Acyclovir