Longitudinal Extensive Transverse Myelitis due to Varicella-Zoster Virus Infection in an Undiagnosed HIV-Positive Patient.

IF 0.9 Q4 CLINICAL NEUROLOGY Case Reports in Neurological Medicine Pub Date : 2024-07-18 eCollection Date: 2024-01-01 DOI:10.1155/2024/9027198
Elahe Yaghmaei, Ahmad Najafi, Reza Daneshvar Kakhki
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Abstract

Introduction: Longitudinal extensive transverse myelitis (LETM) has four main causes: inflammatory, malnutrition, vascular, and infectious causes. Among the commonly described viral causes leading to LETM are the Herpesviridae family, HIV, and HTLV-1. Case Presentation. A 43-year-old man presented with asymmetric weakness of the lower limbs (the left side was weaker), urinary retention, and flank pain. The symptoms began five days after shingle eruption and progressed over twelve days. He was diagnosed with longitudinal extensive transvers myelitis extending from T4 to T6, which corresponded to the same dermatome involved in shingles. The PCR result of cerebrospinal fluid was positive for varicella-zoster virus with a viral load of 500 copies/ml. Additionally, the initial HIV enzyme-linked immunosorbent assay (ELISA) test was positive, and his CD4 count was 72 cells/mm3. Other lab results were normal. Based on the appearance of LETM in the thoracic MRI at T4-T6, VZV myelitis was diagnosed, and treatment was initiated with acyclovir (30 mg/kg divided daily for twenty-one days), methylprednisolone (1 g/day for three days), prophylactic antibiotics (trimethoprim/sulfamethoxazole, rifampin, and isoniazid), and antiretroviral therapy (dolutegravir and Truvada). After 2-month follow-up, he was nearly free of symptoms.

Conclusion: Infection is one of the critical causes of transverse myelitis. When a patient presents with skin shingles along with myelopathy, varicella-zoster myelitis should be considered, and the patient should be evaluated in terms of immune system dysfunction. Treatment with acyclovir has been shown to be effective in reducing clinical symptoms in such cases.

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一名未确诊的 HIV 阳性患者因水痘-带状疱疹病毒感染引发的纵向广泛横贯性脊髓炎
简介纵向广泛性横贯性脊髓炎(LETM)有四种主要病因:炎症、营养不良、血管和感染。导致纵贯广泛性横贯性脊髓炎的常见病毒性病因包括疱疹病毒科、艾滋病病毒和 HTLV-1。病例介绍。一名 43 岁的男子因下肢不对称无力(左侧较弱)、尿潴留和侧腹疼痛就诊。症状开始于带状疱疹爆发后五天,持续了十二天。他被诊断为从 T4 到 T6 的纵向广泛横贯性脊髓炎,这与带状疱疹涉及的皮节相同。脑脊液的 PCR 结果显示水痘-带状疱疹病毒阳性,病毒载量为 500 拷贝/毫升。此外,初次艾滋病毒酶联免疫吸附试验(ELISA)呈阳性,CD4 细胞计数为 72 cells/mm3。其他化验结果正常。根据胸部核磁共振 T4-T6 位置出现的 LETM,诊断为 VZV 脊髓炎,并开始使用阿昔洛韦(30 毫克/千克,每天一次,共 21 天)、甲强龙(1 克/天,共 3 天)、预防性抗生素(三甲双胍/磺胺甲恶唑、利福平和异烟肼)和抗逆转录病毒疗法(多托曲韦和特鲁瓦达)进行治疗。经过两个月的随访,他的症状基本消失:感染是横贯性脊髓炎的重要病因之一。结论:感染是横贯性脊髓炎的重要原因之一。当患者出现皮肤带状疱疹并伴有脊髓病时,应考虑水痘-带状疱疹性脊髓炎,并对患者的免疫系统功能障碍进行评估。使用阿昔洛韦治疗可有效减轻此类病例的临床症状。
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