Unusual Presentation of Varicella zoster Virus Meningitis - Role of Molecular Rapid Diagnostics in Diagnosis and Antimicrobial Stewardship

Varicella-zoster virus aseptic meningitis: an atypical presentation in an immunocompetent male patient

Varicella-zoster virus (VZV) reactivation causes a relatively common disease in immunocompromised patients characterized by rash and radiating pain. Aseptic meningitis is a rare complication of VZV infection and commonly is associated with exanthem and neurological signs. We present an atypical case of VZV meningitis in a healthy 56-year-old male who was initially presented with persistent headache as the only symptom. Anti-VZV immunoglobulin G titer both in serum and in cerebrospinal fluid (CSF) and the polymerase chain reaction (PCR) CSF analysis revealed VZV infection. Our case highlights the importance of considering VZV aseptic meningitis in immunocompetent individuals even in the absence of the typical presentation of meningitis. Screening techniques such as CSF, PCR as well as anti-VZV antibodies in CSF show that VZV meningitis is a common cause of aseptic meningitis and allows the early recognition of CNS involvement in the VZV infection.