MR Features of Varicella-zoster Myelitis in an Immunocompetent Patient. 2023

Yagmur Basak Polat, and Asli Yaman Kula, and Serdar Balsak, and Zeynep Oran, and Alpay Alkan
Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey.

Varicella-zoster virus (VZV) is a latent virus that can remain in the central nervous system. Reactivation of the virus can cause some neurologic manifestations, and myelitis is one of the rarest of them. In this report, we aimed to present the MRI features of long-segment cervical myelitis after VZV infection, which is rarely reported in the literature. A 69-year-old patient, who was diagnosed with varicella-zoster two months ago and treated with valacyclovir, was admitted to our clinic with worsening of his complaints and weakness in the right upper extremity. Neurological examination was normal in the left upper and bilateral lower extremities, but the muscle strength in the right upper extremity was evaluated as 4/5 grade. While rare leukocytes (10 leukocytes/mm³, 50 erythrocytes/mm³, high protein level (46 mg/dl, ref.15- 40 mg/dl)) were seen in the cerebrospinal fluid (CSF) analysis, no microorganisms were seen, and no growth was observed in the culture. VZV antibody-immunoglobulin G (Ab-IgG) was positive in CSF, while polymerase chain reaction [PCR] for VZV was negative. On cervical MRI, lesions showing T2 hyperintensity were observed from the C3-4 level to the C7-T1 level, eccentrically located in the right paramedian spinal cord. On post-contrast images, patchy heterogeneous contrast enhancement was noted in these regions of the spinal cord. When the patient's history, CSF features and MRI examinations were evaluated together, the lesions were consistent with VZV myelitis. The patient was started on valacyclovir treatment, and during the follow-up, the patient's complaints decreased, while no progress was observed in neurologic symptoms. As a result, we aimed to report the MRI features of this rare complication of varicellazoster and emphasize the necessity of keeping this in mind in the etiology of myelitis, especially in cases with patchy enhancement, to achieve early diagnosis and treatment.

UI MeSH Term Description Entries
D008279 Magnetic Resonance Imaging Non-invasive method of demonstrating internal anatomy based on the principle that atomic nuclei in a strong magnetic field absorb pulses of radiofrequency energy and emit them as radiowaves which can be reconstructed into computerized images. The concept includes proton spin tomographic techniques. Chemical Shift Imaging,MR Tomography,MRI Scans,MRI, Functional,Magnetic Resonance Image,Magnetic Resonance Imaging, Functional,Magnetization Transfer Contrast Imaging,NMR Imaging,NMR Tomography,Tomography, NMR,Tomography, Proton Spin,fMRI,Functional Magnetic Resonance Imaging,Imaging, Chemical Shift,Proton Spin Tomography,Spin Echo Imaging,Steady-State Free Precession MRI,Tomography, MR,Zeugmatography,Chemical Shift Imagings,Echo Imaging, Spin,Echo Imagings, Spin,Functional MRI,Functional MRIs,Image, Magnetic Resonance,Imaging, Magnetic Resonance,Imaging, NMR,Imaging, Spin Echo,Imagings, Chemical Shift,Imagings, Spin Echo,MRI Scan,MRIs, Functional,Magnetic Resonance Images,Resonance Image, Magnetic,Scan, MRI,Scans, MRI,Shift Imaging, Chemical,Shift Imagings, Chemical,Spin Echo Imagings,Steady State Free Precession MRI
D009187 Myelitis Inflammation of the spinal cord. Relatively common etiologies include infections; AUTOIMMUNE DISEASES; SPINAL CORD; and ischemia (see also SPINAL CORD VASCULAR DISEASES). Clinical features generally include weakness, sensory loss, localized pain, incontinence, and other signs of autonomic dysfunction. Myelopathy, Inflammatory,Spinal Cord Inflammation,Subacute Necrotizing Myelitis,Infectious Myelitis,Inflammation, Spinal Cord,Inflammations, Spinal Cord,Inflammatory Myelopathies,Inflammatory Myelopathy,Myelitides,Myelitides, Subacute Necrotizing,Myelitis, Infectious,Myelitis, Subacute Necrotizing,Myelopathies, Inflammatory,Necrotizing Myelitides, Subacute,Necrotizing Myelitis, Subacute,Spinal Cord Inflammations,Subacute Necrotizing Myelitides
D002644 Chickenpox A highly contagious infectious disease caused by the varicella-zoster virus (HERPESVIRUS 3, HUMAN). It usually affects children, is spread by direct contact or respiratory route via droplet nuclei, and is characterized by the appearance on the skin and mucous membranes of successive crops of typical pruritic vesicular lesions that are easily broken and become scabbed. Chickenpox is relatively benign in children, but may be complicated by pneumonia and encephalitis in adults. (From Dorland, 27th ed) Varicella,Chicken Pox
D006562 Herpes Zoster An acute infectious, usually self-limited, disease believed to represent activation of latent varicella-zoster virus (HERPESVIRUS 3, HUMAN) in those who have been rendered partially immune after a previous attack of CHICKENPOX. It involves the SENSORY GANGLIA and their areas of innervation and is characterized by severe neuralgic pain along the distribution of the affected nerve and crops of clustered vesicles over the area. (From Dorland, 27th ed) Shingles,Zona,Zoster
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000077483 Valacyclovir A prodrug of acyclovir that is used in the treatment of HERPES ZOSTER and HERPES SIMPLEX VIRUS INFECTION of the skin and mucous membranes, including GENITAL HERPES. 2-((2-Amino-1,6-dihydro-6-oxo-9H-purin-9-yl)methoxy)ethyl L-valinate,256U87,Acyclovir, L-valyl Ester,BW256U87,L-Valylacyclovir,Valaciclovir,Valacyclovir Hydrochloride,Valacyclovir Hydrochloride, (DL)-isomer,Valacyclovir, (D)-isomer,Valacyclovir, (DL)-isomer,Valacyclovir, (L)-isomer,Valacyclovir, D-,Valacyclovir, X-Hydrochloride, (D)-isomer,Valacyclovir, X-Hydrochloride, (DL)-isomer,Valtrex,Acyclovir, L valyl Ester,D- Valacyclovir,L Valylacyclovir,L-valyl Ester Acyclovir
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D014645 Herpesvirus 3, Human The type species of VARICELLOVIRUS causing CHICKENPOX (varicella) and HERPES ZOSTER (shingles) in humans. Chickenpox Virus,Herpes zoster Virus,Ocular Herpes zoster Virus,VZ Virus,Varicella-Zoster Virus,HHV-3,Herpesvirus 3 (alpha), Human,Herpesvirus Varicellae,Human Herpesvirus 3,Chickenpox Viruses,Herpes zoster Viruses,VZ Viruses,Varicella Zoster Virus,Varicella-Zoster Viruses,Varicellae, Herpesvirus

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