Recurrent polymorphonuclear pleocytosis with increased red blood cells caused by varicella zoster virus infection of the central nervous system: Case report and review of the literature

Haug, Aaron; Mahalingam, Ravi; Cohrs, Randall J.; Schmid, D. Scott; Corboy, John R.; Gilden, Don

doi:10.1016/j.jns.2010.01.019

« Previous Next »Journal of the Neurological Sciences
Volume 292, Issue 1 , Pages 85-88, 15 May 2010

Recurrent polymorphonuclear pleocytosis with increased red blood cells caused by varicella zoster virus infection of the central nervous system:

Case report and review of the literature

Aaron Haug
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO, USA
Ravi Mahalingam
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO, USA
Randall J. Cohrs
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO, USA
D. Scott Schmid
- National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
John R. Corboy
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO, USA
- Department of Neurology, Denver Veterans Affairs Medical Center, Denver, CO, USA
Don Gilden
- Department of Neurology, University of Colorado Denver School of Medicine, Aurora, CO, USA
- Department of Microbiology, University of Colorado Denver School of Medicine, Aurora, CO, USA
- Corresponding author. 12700 E. 19th Avenue, Mail Stop B182, Aurora, CO 80045, USA. Tel.: +1 303 7244326; fax: +1 303 7244329.

Received 20 November 2009; received in revised form 12 January 2010; accepted 21 January 2010. published online 22 February 2010.

Abstract

We describe an immunocompetent 45-year-old woman who had four episodes of neurological disease (meningoencephalitis, multifocal vasculopathy, myelitis and inflammatory brain stem disease) produced by varicella zoster virus (VZV) over an 11-month period, all in the absence of rash. The cerebrospinal fluid (CSF) contained anti-VZV IgG antibody, but not VZV DNA throughout her illness, reaffirming the superiority of detection of anti-VZV IgG in CSF compared to VZV DNA in diagnosing VZV infection of the nervous system. Moreover, 3 of 7 CSF samples examined during the 11months showed a VZV-induced pleocytosis consisting predominantly of polymorphonuclear cells (PMNs), and 4 of 7 samples also contained increased numbers of red blood cells (RBCs). Because increased PMNs and RBCs in CSF can also occur in patients with central and peripheral nervous system disease produced by cytomegalovirus (CMV), the differential diagnosis of chronic nervous system infection with increased PMNs and RBCs in CSF should include analyses for both VZV and CMV.

Keywords: VZV, Recurrent vasculopathy, Myelitis, Polymorphonuclear cells, Red blood cells