P0058 Rare varicella-zoster aseptic meningitis without rash: the evolving role of polymerase chain reaction methods in diagnosis and treatment

Charalampos Moschopoulos*1, Stavroula Chachali1, Nikolaos Siafakas2, Anastasia Papadioti2, Antonios Papadopoulos1

14th Department of Internal Medicine, University General Hospital ''ATTIKON'', National and Kapodistrian University of Athens, Greece, 2Department of Clinical Microbiology, University General Hospital ''ATTIKON'', National and Kapodistrian University of Athens, Greece

Background: Varicella Zoster Virus (VZV) is an exclusively human herpesvirus, that causes chickenpox, becomes latent in cranial-nerve and dorsal-root ganglia, and frequently reactivates decades later to produce shingles (zoster). Central Nervous System (CNS) infection with VZV reactivation in young immunocompetent adults is rare and unexpected, and only very few cases have been described so far in the world literature.

Materials/methods: Here we report two cases of otherwise healthy young men who were diagnosed with VZV meningitis without development of rash. They both complained of fever and headache that lasted for 7 days. Their clinical examination and vital signs were unremarkable, besides the persisting fever, and without any neurological deficit or rash. Laboratory values of complete blood count and biochemical markers were between normal limits. Cerebrospinal luid (CSF) analysis showed a raised leucocyte blood count (538 and 680 cells/μL, respectively) with absolute lymphocytic predominance and elevated protein. Further CSF examination with PCR (FilmArray multiplex PCR and RT-PCR) revealed VZV infection, other causes excluded, and suitable antiviral treatment was provided. Previous chickenpox was confirmed with the presence of specific IgG antibodies in the patients’ serum at presentation. Both patients had favorable outcome, with complete clinical response and improved CSF parameters, after two weeks of treatment. They never developed any rash.

Conclusions: Viral meningitis is the most common cause of aseptic meningitis. PCR-based methods have increased the ability to detect particular etiologic factors and provided the chance for etiologic treatment, especially in the case of VZV and HSV infection. VZV emerges as the second most common pathogen detected in viral meningitis, only after Enteroviruses, even in the absence of skin lesions.