Primary varicella (chickenpox) and herpes zoster (shingles) are caused by the highly contagious varicella zoster virus (VZV). Due to underlying immunological dysfunction, people with rheumatoid arthritis (RA) may be more vulnerable to serious infection. A 52-year-old woman with rheumatoid arthritis, who was receiving hydroxychloroquine and sulfasalazine, is the subject of our case study. She had a broad vesicular rash, subtle cognitive difficulties, and VZV hepatitis, a known complication of disseminated infection. Through positive immunoglobulin M (IgM), immunoglobulin G (IgG), and polymerase chain reaction (PCR) detection of VZV deoxyribonucleic acid (DNA) in blood and cerebrospinal fluid (CSF), laboratory studies verified the spread of VZV. Our case highlights behavioral shift as a unique presentation of VZV encephalopathy. An interdisciplinary approach continues to be important in the management of such complicated cases, with timely interventions and better outcomes.
References
[1]
Lizzi, J., Hill, T. and Jakubowski, J. (2019) Varicella Zoster Virus Encephalitis. ClinicalPracticeandCasesinEmergencyMedicine, 3, 380-382. https://doi.org/10.5811/cpcem.2019.8.43010
[2]
Thomas, S.L. and Hall, A.J. (2004) What Does Epidemiology Tell Us about Risk Factors for Herpes Zoster? TheLancetInfectiousDiseases, 4, 26-33. https://doi.org/10.1016/s1473-3099(03)00857-0
[3]
Listing, J., Gerhold, K. and Zink, A. (2013) The Risk of Infections Associated with Rheumatoid Arthritis, with Its Comorbidity and Treatment. Rheumatology, 52, 53-61. https://doi.org/10.1093/rheumatology/kes305
[4]
Herlin, L.K., Hansen, K.S., Bodilsen, J., Larsen, L., Brandt, C., Andersen, C.？., et al. (2020) Varicella Zoster Virus Encephalitis in Denmark from 2015 to 2019—A Nationwide Prospective Cohort Study. ClinicalInfectiousDiseases, 72, 1192-1199. https://doi.org/10.1093/cid/ciaa185
Hokkanen, L. and Launes, J. (2000) Cognitive Outcome in Acute Sporadic Encephalitis. NeuropsychologyReview, 10, 151-167. https://doi.org/10.1023/a:1009079531196
[7]
Venkatesan, A., Tunkel, A.R., Bloch, K.C., Lauring, A.S., Sejvar, J., Bitnun, A., et al. (2013) Case Definitions, Diagnostic Algorithms, and Priorities in Encephalitis: Consensus Statement of the International Encephalitis Consortium. ClinicalInfectiousDiseases, 57, 1114-1128. https://doi.org/10.1093/cid/cit458
[8]
Vangiliappan, K., Venkatraman, C., Samivel, B., Lakshmi Narasimhan, R. and Govindarajan, S. (2019) A Study on Neurological Manifestations of Primary Varicella Zoster Virus Infection. Neurology Asia, 24, 9-14.
Alvarez, J.C., Alvarez, J., Ticono, J., Medallo, P., Miranda, H., Ferrés, M., et al. (2020) Varicella-Zoster Virus Meningitis and Encephalitis: An Understated Cause of Central Nervous System Infections. Cureus, 12, e11583. https://doi.org/10.7759/cureus.11583
