Rinsho Shinkeigaku (Clinical Neurology)

Case Report

Varicella-zoster virus infection with concomitant lower cranial polyneuropathy in the absence of fever, headache and meningeal signs

Keishu Murakami, M.D.1)2)3), Kazunori Kanzaki, M.D.1)3)4), Yoshinori Kajimoto, M.D.1)5) and Hidefumi Ito, M.D., Ph.D.3)

1) Department of Neurology, Wakayama Rosai Hospital
2) Department of Neurology, Shingu Municipal Medical Center
3) Department of Neurology, Wakayama Medical University
4) Tabuse Home Clinic
5) Department of Internal Medicine, Wakayama Medical University Kihoku Hospital

We present varicella-zoster virus (VZV) infection with concomitant lower cranial polyneuropathy in the absence of meningeal symptoms. Physical examination showed involvement of cranial nerves IX and X in Case 1 and of cranial nerves IX, X, and XI in Case 2. Cerebrospinal fluid (CSF) analysis revealed mild lymphocytic pleocytosis, normal protein levels, and absence of VZV-DNA based on polymerase chain reaction (PCR) analysis. Serum anti-VZV antibody testing showed positive results in both cases, which confirmed the diagnosis of VZV infection. VZV infection accompanied by lower cranial polyneuropathy is rare; therefore, it is important to consider VZV reactivation as an etiopathogenetic contributor to pharyngeal palsy and hoarseness. We emphasize the importance of serological analysis for precise diagnosis in VZV infection with multiple lower cranial nerve palsies because the VZV-DNA PCR test may show negative results in patients without meningitis symptoms or in those with normal CSF protein levels.
Full Text of this Article in Japanese PDF (967K)

(CLINICA NEUROL, 63: 225－230, 2023)
key words: varicella-zoster virus, lower cranial polyneuropathy, meningitis, meningismus, polymerase chain reaction

(Received: 10-Nov-22)