Varicella Zoster Virus Related Myelo-Radiculo-Neuropathy: Case Report

Aim: Varicella zoster virus (VZV) infections can cause various neurological syndromes during primary infection or reactivation periods. We report two rare neurological complications of VZV, acute longitudinally extensive myelitis and acute motor axonal neuropathy due to primary chickenpox infection that occurred concomitantly. Case: A 76-year-old female patient presented with skin lesions consistent with chickenpox all over the body and walking difficulty ten days ago. Neurological examination revealed paraparesis and areflexia. Spinal cord magnetic resonance imaging revealed a long-segment transverse myelitis lesion involving the lower cervical and thoracic levels. Elevated protein and the presence of VZV DNA were detected in the cerebrospinal fluid, and VZV IgM was detected in the serum. Two days later, the patient's weakness in her legs increased. Electromyography showed signs of acute axonal motor polyneuropathy. The patient was treated with intravenous immunoglobulin after high-dose steroid and antiviral therapy. Partial recovery was observed. Conclusion: Transverse myelitis and Guillain Barré syndrome are rare complications of VZV infection. Our case is first case where these two neorological conditions related to VZV were seen in the same patient.