SHM Converge Scientific Abstract ePoster Gallery-An Unsuspected Case of Varicella-Zoster Virus Encephalitis

Pdf Summary

This case report describes a 51-year-old man who presented with acute altered mental status and was initially suspected to have ingested an unknown toxin or substance. He had a headache two days earlier, followed by body aches, then was found difficult to arouse and speaking inappropriately. In the emergency department, he was hemodynamically stable, and initial testing, including urine drug screen, blood alcohol level, CT head, and chest X-ray, was negative. Because of concern for meningitis or encephalitis, a lumbar puncture was performed, which was positive for varicella-zoster virus (VZV).<br /><br />He was initially treated with ampicillin and vancomycin, then switched to intravenous acyclovir and ceftriaxone after the LP results returned. Brain MRI later showed mild sinusitis but was otherwise unremarkable. After treatment, he improved, was extubated, returned to baseline mental status, and was discharged home in stable condition. Notably, he denied a history of chickenpox.<br /><br />The discussion emphasizes that VZV can reactivate after latency in nerve ganglia and cause neurological disease such as meningitis, meningoencephalitis, encephalitis, cranial neuropathies, myelopathy, and cerebrovascular complications. The authors note that VZV encephalitis may not show a strong seasonal pattern.<br /><br />The main takeaway is that in patients with hyperacute or acute altered mental status, clinicians should keep meningitis and encephalitis high on the differential, obtain a thorough history and neurologic exam, and perform lumbar puncture promptly when suspicion is high.

Asset Subtitle

Sara Hassan

Meta Tag

Author List Apurva Patel, Brian Kerr, Sara Hassan

Category Clinical Vignettes

Concept Meningitis

Concept Encephalitis

Concept Altered Mental Status

Concept Varicella-Zoster Virus

Concept Lumbar Puncture

Distinguished Non-Finalist

Presenter Organization Ocean University Medical Center

Presenting Author Sara Hassan

Track Adult

Keywords

varicella-zoster virus

VZV encephalitis

altered mental status

meningoencephalitis

lumbar puncture

acyclovir

meningitis

neurological infection

acute confusion

case report

Meningitis

Encephalitis

Altered Mental Status

Varicella-Zoster Virus

Lumbar Puncture