Atypical varicella-zoster virus meningitis in a young immunocompetent adult during enterovirus epidemic season: A case report and literature review

Abstract

Background Varicella-zoster virus (VZV) can cause acute brain infection manifesting as meningitis or encephalitis, which more likely occurs in winter and population with immunocompromised conditions^[1]. During the enterovirus epidemic season, VZV meningitis is easy to be ignored and misdiagnosed, especially when the typical dermatomal rash is absent. Case presentation Here, we present an atypical case of a young immunocompetent male with VZV meningitis and encephalitis during summer. The patient presented with fever, headache and vomiting, but without dermatomal rash. Metagenomic Next-generation Sequencing (mNGS) of cerebrospinal fluid (CSF) revealed VZV infection. He was treated successfully with acyclovir and recovered without any neurological sign. Conclusions This case report describes a patient with mild diabetes but no immunocompromised condition who developed meningitis and encephalitis resulting from VZV infection in summer. Additionally, there is no dermatomal rash in the patient. It can broaden the understanding of the disease, and keep VZV infection in differential diagnoses of viral meningitis.