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- Title
Avoiding a lumbar puncture may be a rash decision: a case report of varicella-zoster virus-associated radiculopathy in advanced HIV infection.
- Authors
Wallis, Emma; Al-Hakim, Bahij; Holmes, Paul; Douthwaite, Sam; Kulasegaram, Ranjababu
- Abstract
A 34-year-old man recently diagnosed with advanced human immunodeficiency virus infection (CD4 cell count of 139 cells/mm3), not yet started on antiretroviral medications, presented to hospital with a ten-day history of left leg weakness and difficulty walking. He described a childhood history of chickenpox with previous shingles over his buttock over three years ago. Examination revealed reduced power in the left hip and knee flexors and absent knee and adductor reflexes. Lumbar punctures were performed and polymerase chain reaction (PCR) detected varicella-zoster virus (VZV) DNA. Concurrent serum samples for VZV PCR were negative. The patient was diagnosed with VZV radiculopathy and treated with high-dose intravenous acyclovir. Within two days, neurological signs improved. Previous case reports define VZV radiculopathy by a temporal and geographical relationship with a zoster rash. Our diagnosis was based on a clinical picture of radiculopathy with virological evidence in CSF and confirmed by a dramatic clinical response to treatment. We propose that lumbar puncture and detection of VZV DNA by PCR in the cerebrospinal fluid (CSF) is an invaluable investigation that should be considered in the workup of immunosuppressed patients presenting with a radiculopathy.
- Subjects
CHICKENPOX; RADICULOPATHY; HIV infections; LUMBAR puncture; CD4 lymphocyte count; VARICELLA-zoster virus; POLYMERASE chain reaction
- Publication
International Journal of STD & AIDS, 2019, Vol 30, Issue 10, p1031
- ISSN
0956-4624
- Publication type
journal article
- DOI
10.1177/0956462419856231