SHM Converge Scientific Abstract ePoster Gallery-Uncommon Manifestation of Disseminated Zoster Transverse Myelitis

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This case report describes an uncommon presentation of disseminated herpes zoster causing longitudinally extensive transverse myelitis (LETM) in an immunocompetent 74-year-old man. He presented with 5 days of left upper extremity weakness and paresthesia, beginning in the hand and radiating to the shoulder, without leg weakness or bowel/bladder symptoms. He later reported a recent episode of painful left forearm vesicles that crusted over about a week earlier.<br /><br />Examination showed erythematous plaques in a C7–8 distribution, left arm weakness, reduced grip strength, and diminished biceps reflexes. Laboratory studies revealed elevated inflammatory markers, and Varicella Zoster IgM and IgG were positive. Skin biopsy PCR and cerebrospinal fluid PCR were both positive for VZV, with CSF showing lymphocytic pleocytosis. MRI of the cervical spine demonstrated a C3–C7 spinal cord lesion consistent with transverse myelitis.<br /><br />The patient had a history of childhood varicella and had received at least one dose of Shingrix, but had no known malignancy or immunocompromising condition. He was treated with 21 days of IV acyclovir and 10 days of IV steroids, then discharged to rehabilitation on a prednisone taper with improving symptoms.<br /><br />The authors emphasize that VZV-associated transverse myelitis is rare, especially in immunocompetent patients, and may occur alongside or shortly after zoster rash. Early recognition with MRI and CSF testing is important because delayed treatment can lead to significant neurologic decline. This case highlights the need to consider transverse myelitis and other neurologic complications in patients with disseminated herpes zoster, even when they are not immunocompromised.

Asset Subtitle

Michelle J. Hornedo Tosado

Meta Tag

Author List Michael Hardman, Michelle J. Hornedo Tosado

Category Clinical Vignettes

Concept Varicella-Zoster Virus

Concept Transverse Myelitis

Concept Herpes Zoster

Concept Acyclovir

Concept Longitudinally Extensive Transverse Myelitis

Distinguished Non-Finalist

Presenter Organization Riverside Methodist Hospital OhioHealth

Presenting Author Michelle J. Hornedo Tosado

Track Adult

Keywords

disseminated herpes zoster

longitudinally extensive transverse myelitis

LETM

varicella zoster virus

VZV PCR

immunocompetent

cervical spinal cord lesion

cerebrospinal fluid pleocytosis

IV acyclovir

neurologic complications

Varicella-Zoster Virus

Transverse Myelitis

Herpes Zoster

Acyclovir

Longitudinally Extensive Transverse Myelitis