A Case Report on Varicella zoster Encephalitis Vasculopathy
1 Department of Pharmacy Practice, Nazareth college of Pharmacy, Othera, Kerala, India.
2 Department of Clinical Hematology, Believers Church Medical College Hospital, Thiruvalla, Kerala, India.
3 Department of Diagnostic Radiology, St Gregorios Hospital Parumala, Kerala, India.
4 Department of Pharmacy Practice, Al- Shifa College of Pharmacy, Perinthalmanna, Kerala, India.
Case Report
Open Access Research Journal of Medical and Clinical Case Reports, 2025, 02(02), 001-007
Article DOI: 10.53022/oarjmccr.2025.2.2.0023
Publication history:
Received on 31 July 2025; revised on 27 August 2025; accepted on 01 September 2025
Abstract:
Varicella zoster virus (VZV) encephalopathy is a rare but serious complication of viral reactivation, particularly in immunocompromised individuals. We report the case of an 83- year-old female with a background of autoimmune hemolytic anemia and high-grade B-cell non-Hodgkin lymphoma, previously treated with immunotherapy and chemotherapy and was in complete remission who presented after 1 year with fever, altered mental status, and a generalized vesicular rash. MRI brain revealed T2/FLAIR parieto-occipital hyperintensities and multifocal infarcts suggestive of vasculopathy/acute infarct. Cerebrospinal fluid multiplex PCR confirmed the presence of VZV. The patient had profound hypogammaglobulinemia, and was treated with intravenous immunoglobulin. Despite best supportive management, her neurological condition rapidly deteriorated. This case underscores the importance of maintaining a high index of suspicion for VZV encephalopathy in elderly, immunocompromised patients presenting with encephalopathy and rash. Early CSF analysis and neuroimaging are essential for diagnosis, and timely diagnosis and aggressive management may influence the outcomes in such high-risk populations.
Keywords:
Varicella Zoster Virus; Encephalitis; Vasculopathy; Non- Hodgkin Lymphoma; Immunocompromised patients; Central nervous system
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