Long-term outcomes of varicella zoster virus infection-related myelitis in 10 immunocompetent patients

Abstract Objective To describe the clinical presentation and long-term disease outcomes of varicella zoster virus (VZV) infection–related myelitis (VZVM) in immunocompetent patients. Method A series of 10 immunocompetent patients with VZVM were retrospectively observed and followed (3–96 months). Results The onset of myelitis was timed in relation to the appearance of VZV-associated rash (−3 to 50 days). Rash locations included the cervical (5), thoracic (2), and lumbar (3) dermatomes, whereas myelitis localized to the cervical (6) and thoracic (9) spinal cord and the medulla (1). Spinal MRI revealed extensive longitudinal transverse myelitis in nine patients, with multiple segmental lesions (≥2 segments) evident in five patients. Aquaporin-4, myelin oligodendrocyte glycoprotein, ganglioside Q1b, and ganglioside T1b antibodies were detected in some patients. Three patients fulfilled the 2015 diagnostic criteria for neuromyelitis optica spectrum disease, of whom two relapsed. Seven patients were treated with intravenous antivirals and methylprednisolone, with the remaining three patients receiving methylprednisolone only. Ongoing immunosuppressive therapy was provided for two patients who experienced relapses. To date, no patients have reported VZV reactivation. Over the course of follow-up, the Expanded Disability Status Scale (EDSS) score deceased from 4.9 to 2.6 on average. Conclusions VZVM runs a relatively benign course in immunocompetent patients, although relapses can occur depending on patient immune status. A comprehensive evaluation of patient's autoimmune condition is recommended.