Case Reports in Neurological Medicine / 2014 / Article / Tab 1

Case Report

Varicella Zoster Virus Meningitis in a Young Immunocompetent Adult without Rash: A Misleading Clinical Presentation

Table 1

Clinical and CSF findings in immunocompetent patients with VZV meningitis without rash. Qalb: albumin quotient (CSF albumin/serum albumin), OCB: oligoclonal bands, and ASI: antibody specific index ((CSF VZV-IgG/serum VZV-IgG)/(CSF total-IgG/serum total-IgG)). MRI results of patient 4: MRI revealed an ill-defined T2 hyperintensity in the right frontal lobe, extending from the cortical surface to the frontal horn of the lateral ventricle without mass effect, consistent with a hamartoma or cortical dysplasia. A follow-up MRI with gadolinium on day 10 was normal, with no change in the solitary T2 hyperintensity.

PatientsAge/
gender
SymptomsDuration of symptoms (days)Clinical signsPrevious diseasesBrain imagingCerebrospinal fluidReference
Cells/μLCells
(%)
Protein
(mg/L)
Lactate
(mmol/L)
QalbOCBVZV DNAVZV ASI

118/maleHeadache, nausea, vomiting9Examination normal, no rashNone MRI: normal172096% lymphocytes, 3% plasma cells, 1% monocytes14603.019.7Type 350 000 copies/mL74.9Our case
No symptoms48Examination normal, no rashNonen.d.1995% lymphocytes, 5% monocytes6131.68.1Type 3Negative21.5Our case

253/femaleHeadache, nausea, photophobia, generalized body aches3Examination normal, no rashDiabetes mellitus, bronchial asthma, bipolar diseaseCT: mild atrophy92398% lymphocytes, 2% monocytes16503.1n.d.n.d.Positiven.d.Klein et al., 2010 [8]

312/male Headache4Examination normal, no rashBronchial asthma CT: normal59097% lymphocytes, 1% monocytes, 2% neutrophils860n.d.n.d.n.d.Positiven.d.Jhaveri et al., 2003 [5]

426/femaleHeadache, nausea, photophobia, vomiting6Examination normal, no rashNoneMRI (see legend)33199% mononuclear2190n.d.n.d.n.d.127 000 copies/mLn.d.Habib et al. 2009 [7]

514/maleHeadache, photophobia, vomiting7Examination normal, no rashMigraineMRI: normal285n.d.1580n.d.n.d.n.d.Positiven.d.Leahy et al., 2008 [6]

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