Varicella-zoster virus related cerebral infarction in an AIDS patient

SA Ren-Tian; CHENG Cong; WEI Hong-Xia

Journal of Microbes and Infections ›› 2025, Vol. 20 ›› Issue (4) : 227-233.

Author information +

History +

Abstract

Varicella-zoster virus (VZV) can infect the nervous system, but there are few reports of cerebral infarction caused by VZV in Acquired Immune Deficiency Syndrome (AIDS) patients. This paper reported a case of an AIDS patient who initially presented with herpes zoster neuralgia without a rash. After antiviral treatment with acyclovir for VZV, pain relief, and antiretroviral treatment with Bictegravir Sodium/Emtricitabine/Tenofovir Alafenamide Fumarate Tablets (BIC/FTC/TAF) for human immunodeficiency virus (HIV). The patient improved and was discharged. After 8 days, the patient developed a fever along with unclear speech, nausea, and vomiting. VZV-related meningoencephalitis was confirmed through lumbar puncture and magnetic resonance imaging. The VZV DNA in cerebrospinal fluid reached 44,251 copies/mL. Ganciclovir, foscarnet sodium, acyclovir (anti-VZV), and dexamethasone (anti-inflammatory) were administered sequentially. After improvement, acyclovir, an anti-VZV medication, was taken orally.Thirty five days later, the patient suffered from acute cerebral infarction in the left frontoparietal lobe, resulting in paralysis of the right limb and aphasia. Lumbar puncture showed that the cerebrospinal fluid contained 1200 copies/ml of VZV DNA. Ganciclovir combined with foscarnet sodium for anti-VZV, BIC/FTC/TAF for anti-HIV, methylprednisolone for anti-inflammatory purposes, aspirin for antiplatelet effects, and atorvastatin for plaque stabilization showed improvement. AIDS patients with VZV infection may develop cerebral infarction. Therefore, close attention should be paid to the patients with neurological symptoms to reduce the mortality and disability rate of such patients.

Key words

Acquired Immune Deficiency Syndrome / Human immunodeficiency virus / Varicella-zoster virus / Cerebral Infarction / Meningoencephalitis / Nervous System / Herpes Zoster without Rash

Cite this article

EndNote

Ris (Procite)

Bibtex

Download Citations

Varicella-zoster virus related cerebral infarction in an AIDS patient[J]. Journal of Microbes and Infections. 2025, 20(4): 227-233

References

[1]Arvin AM.Varicella-zoster virus[J].Clin Microbiol Rev, 1996, 9(3):361-381 [2]Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, Grose C, Hambleton S, Kennedy PG, Oxman MN, Seward JF, Yamanishi K.Varicella zoster virus infection[J].Nat Rev Dis Primers, 2015, 1:15016- [3]Gilden DH, Kleinschmidt-DeMasters BK, LaGuardia JJ, Mahalingam R, Cohrs RJ.Neurologic complications of the reactivation of varicella-zoster virus[J].N Engl J Med, 2000, 342(9):635-645 [4]De La Blanchardiere A, Rozenberg F, Caumes E, Picard O, Lionnet F, Livartowski J, Coste J, Sicard D, Lebon P, Salmon-Cèron D.Neurological complications of varicella-zoster virus infection in adults with human immunodeficiency virus infection[J].Scand J Infect Dis, 2000, 32(3):263-269 [5]Weller TH.Varicella and herpes zosterChanging concepts of the natural history,control,and importance of a not-so-benign virus[J].N Engl J Med, 1983, 309(23):1434-1440 [6]Miravet E, Danchaivijitr N, Basu H, Saunders DE, Ganesan V.Clinical and radiological features of childhood cerebral infarction following varicella zoster virus infection[J].Dev Med Child Neurol, 2007, 49(6):417-422 [7]Wu H, Wang R, Li Y, Sun X, Li J, Bi X.Cerebrovascular Complications After Adult-Onset Varicella-Zoster Virus Encephalitis in the Central Nervous System: A Literature Review[J].Neuropsychiatr Dis Treat, 2022, 18:449-462 [8]薛晓琳, 宋春杰, 曾彦英.水痘-带状疱疹病毒性脑血管炎的临床表现以及影像学、病理学改变[J].中国神经免疫学和神经病学杂志, 2007, 14(2):105-108 [9]Yamashiro N, Nagasaka T, Ooishi N, Tsuchiya M, Takaki R, Kobayashi F, Shindo K, Takiyama Y.An Autopsy Case of Meningoencephalitis and Cerebral Infarction that Developed with Ramsay Hunt Syndrome and Disseminated Herpes Zoster][J].Brain Nerve, 2018, 70(3):253-258 [10]Pham TV, Torres M.Human Immunodeficiency Virus Infection-Related Heart Disease[J].Emerg Med Clin North Am, 2015, 33(3):613-622 [11]Rerkasem A, Sripan P, Pongtam S, Ounjaijean S, Kulprachakarn K, Wongthanee A, Chaiwarith R, Supparatpinyo K, Salee P, Arworn S, Rerkasem K.The Prevalence and Risk Factors for Peripheral Arterial Disease in Adults Living With Human Immunodeficiency Virus[J].Int J Low Extrem Wounds, 2023, 22(2):332-338 [12]Rodriguez VJ, Chahine A, Parrish MS, Alcaide ML, Lee TK, Hurwitz B, Sawhney M, Weiss SM, Jones DL, Kumar M.The contribution of syndemic conditions to cardiovascular disease risk[J].AIDS Care, 2021, 33(5):585-593 [13]Ishikawa K, Kawai F, Mori N.Increased human immunodeficiency virus viral load with cerebral infarction due to varicella zoster virus vasculopathy on treatment with bictegraviremtricitabinetenofovir alafenamide suspension: a case report and literature review[J].AIDS Res Ther, 2023, 20(1):53- [14]代丽丽, 陈仁芳, 陈耀凯, 丁海波, 何云, 画伟, 黄辉煌, 靳娟, 李侠, 刘水青, 吕玮, 马萍, 沈银忠, 王辉, 王立静, 王茜, 王汝刚, 辛若雷, 喻剑华, 张凤池, 张福杰, 张仁芳, 赵红心, 赵清霞, 周莹荃, 朱彪, 孙丽君.快速启动艾滋病抗病毒治疗专家共识[J].中国艾滋病性病, 2023, 29(7):737-744 [15]中华医学会感染病学分会艾滋病丙型肝炎学组, 中国疾病预防控制中心.中国艾滋病诊疗指南(2021年版)[J].中华传染病杂志, 2021, 39(12):715-735 [16]Powell DR, 2nd, Patel S, Franco-Paredes C.Varicella-Zoster Virus Vasculopathy: The Growing Association Between Herpes Zoster and Strokes[J].Am J Med Sci, 2015, 350(3):243-245 [17]Vibha D, Prabhakar S, Khurana D, Khandelwal N.Varicella zoster vasculopathy presenting as lateral medullary syndrome[J].J Neurovirol, 2012, 18(6):538-540 [18]Mehta A, Arora A, Sharma M, Malik R, Porwal YC.Hemorrhagic Stroke and Cerebral Venous Thrombosis: Rare Neurological Sequelae of Chickenpox Infection[J].Ann Indian Acad Neurol, 2018, 21(3):228-232 [19]Silver B, Nagel MA, Mahalingam R, Cohrs R, Schmid DS, Gilden D.Varicella zoster virus vasculopathy: a treatable form of rapidly progressive multi-infarct dementia after 2 years' duration[J].J Neurol Sci, 2012, 323(1-2):245-247