Table 1.

Characteristics of an immunocompetent adolescent with herpes zoster and aseptic meningitis due to VZV reactivation

Characteristics	Data
Demographics
Age	14 years
Gender	Male
Previous history
Age at time of developing varicella	3 years
Clinical problems	Recurrent respiratory tract infections in the first three years of life
Clinical presentation upon admission
Axillary temperature	37.8°C
Skin lesions	Dorsal herpes zoster (C8)
Neurological symptoms and signs	Headache, slowness, drowsiness, unable to tolerate bright light, vomiting, stiff neck, exaggerated deep tendon reflexes, positive Brudzinski’s and Kernig’s signs
Diagnostic examinations upon admission
White blood count	7,280/μL
Lymphocytes	31.7%
C-reactive protein	0.10 mg/dL
CSF examination	Protein 95 mg/dL, glucose 48 mg/dL, 1,400 lymphocytes/μL, PCR positive for VZV DNA 1,250 cp/mL, PCR negative for herpes simplex virus 1 and 2, enterovirus, cytomegalovirus, Epstein Barr virus, JC virus
Immunological screening	HIV negative, normal lymphocyte subpopulation counts, normal serum immunoglobulin and complement levels, vaccine responsiveness and lymphocytes stimulation tests
Electroencephalography	Normal
CT and MR	Normal
Antiviral therapy
Oral acyclovir	400 mg 3 times a day for 48 hours (administered at home before neurological involvement)
Intravenous acyclovir	10 mg/kg 3 times a day for 10 days (administered after admission because of meningitis)
Outcome
Duration of fever	2 days
Duration of neurological involvement	4 days
Duration of vescicular eruption	7 days
Duration of hospitalisation	10 days
Clinical evaluation after one month	Normal with absence of neurological involvement

CSF: cerebrospinal fluid; CT: computed tomography; MR: magnetic resonance; PCR: polymerase chain reaction; VZV: varicella zoster virus.