Abstract
Objective: To describe the clinical characteristics, laboratory findings, and treatment outcomes of meningitis in patients with herpes zoster and cutaneous lesion.
Materials and Methods: We conducted a descriptive case series of 15 patients diagnosed with Varicella zoster virus (VZV) meningitis at the Department of Dermatology and Burns, Bach Mai Hospital. Demographic data, clinical manifestations, cerebrospinal fluid (CSF) findings, VZV PCR results, magnetic resonance imaging (MRI) findings, and treatment outcomes were analyzed.
Results: The median age was 59.9 years; 53.3% were aged ≥60 years and 46.7% were male. The median interval from rash onset to neurological symptom development was 4.9 days. Headache was present in all patients (100%), whereas classical meningeal signs were uncommon (neck stiffness in 20%); no cases of fever, altered consciousness, or seizures were observed. Cutaneous lesions were localized to the head–face–neck region in all cases. CSF analysis demonstrated moderate pleocytosis (median 129.7 cells/mm³) with lymphocytic predominance (61.5%), mildly elevated protein (0.72 g/L), and normal glucose levels. VZV PCR was positive in 86.7% of patients. No abnormal findings were detected on brain MRI. All patients received intravenous acyclovir for a median duration of 11.5 days; adjunctive corticosteroids were administered in 20% of cases. Clinical outcomes were favorable, with complete recovery in all patients and no neurological sequelae or mortality.
Conclusion: VZV meningitis in patients with herpes zoster and cutaneous lesions often presents with atypical clinical features, predominantly isolated headache without classical meningeal signs. CSF analysis and VZV PCR are essential for diagnosis. Early initiation of intravenous acyclovir is associated with an excellent prognosis.