Table 2.
Reported Cases of Varicella-Zoster Virus Myelitis or Myeloradiculitis in Patients With HIV
| Reference/Year Reported | Age at Presentation, Sex | On ARVs at Diagnosis | CD4+ Count (Cells/μL) | Clinical Syndrome | Treatment | Outcome |
|---|---|---|---|---|---|---|
| Present case | 50, M | No | 35 | Meningomyeloradiculitis with partial Brown-Séquard syndrome | Methylprednisolone × 1 wk | Partial neurological recovery |
| Thoracic zoster | Acyclovir IV × 6 wk | |||||
| Valacyclovir × 8 wk | ||||||
| Antiretrovirals | ||||||
| [20] 2010 | 24, M | Yes | NR | Myeloradiculitis of the cauda equina | Acyclovir IV × 3 wk | Survived with normalization of CSF |
| Disseminated rash | ||||||
| [23] 2009 | 41, F | Yes | 155 | Necrotizing myelitis with meningoencephalitis resulting in bulbar palsy and respiratory failure | Dexamethasone IV | Died |
| Six vesicular lesions on anterior chest | Acyclovir IV | |||||
| Ceftriaxone IV | ||||||
| Benzylpenicillin | ||||||
| [13] 2004 | 48, M | Yes | 10 | Multilevel transverse myelitis | Methylprednisolone × 3 d | Partial neurological recovery |
| No rash | Valacyclovir | |||||
| [24] 1996 | 31, M | No | 6 | Myelitis (T8 level) | Acyclovir IV | Signed out against medical advice |
| Thoracic zoster | ||||||
| [24] 1996 | 47, M | NR | NR | Myelitis (T3–T5 level) | Acyclovir IV × 7 d | Partial neurological recovery |
| Trigeminal zoster | Famciclovir | |||||
| Dexamethasone IV × 7 d | ||||||
| Foscarnet × 3 d | ||||||
| Clindamycin × 2 d | ||||||
| Pyrimethamine × 2 d | ||||||
| Leucovorin × 2 d | ||||||
| [25] 1996 | 29, M | Yes | 16 | Myelopathy (T10 level) with urinary retention and no findings on spinal MRI | Acyclovir IV × 21 d | Complete neurological recovery |
| Thoracic zoster | Acyclovir oral | |||||
| [25] 1996 | 35, F | Yes | 5 | Bilateral palsies of cranial nerves VII and VIII resulting in deafness | Acyclovir IV × 35 d | Partial neurological recovery |
| Encephalopathy | Acyclovir oral | |||||
| Brown-Séquard syndrome | Withdrawal of antiretroviral | |||||
| Cervical zoster | ||||||
| [14] 1995 | 35, M | Yes | 32 | Diffuse necrotic myeloradiculitis | NR | Died |
| No rash | ||||||
| [26] 1994 | 40, M | Yes | 239 | Ascending myelopathy (T5 level) with complete paraplegia, urinary retention and no findings on spinal MRI | Acyclovir oral | Survived without any neurological recovery |
| Thoracic zoster | Died | |||||
| [27] 1994 | 42, M | No | 3 | Meningomyeloradiculitis | Gancyclovir IV | |
| (C4–C7 level) | Syphilis treatment | |||||
| Ophthalmic zoster | ||||||
| [27] 1994 | 40, M | No | NR | Myeloradiculitis | NR | Died |
| Thoracic zoster | ||||||
| [15] 1994 | 41, M | No | 20 | Cervical myelitis | Prednisone | Died |
| No rash | Acyclovir oral | |||||
| [22] 1993 | 30, M | No | 290 | Ventriculitis and meningomyeloradiculitis (T5 level) | Antiretrovirals | Died |
| No rash | ||||||
| [28] 1991 | 36, M | NR | NR | Thoracic transverse myelitis | NR | Died |
| Thoracic zoster |
Abbreviations: ARV, antiretrovirals; CSF, cerebrospinal fluid; IV, intravenous; MRI, magnetic resonance imaging; NR, not reported.