Varicella Zoster Virus Myelitis: A Report of Two Cases with Unusual Presentation (P02.268)

Objective: We report two patients with varicela-zoster virus (VZV) myelitis. The first was an inmunocompetent patient with an unusual clinical presentation: the second was a patient with relapsing-remitting multiple sclerosis (RRMS) in which the medullar symptoms preceded the cutaneous rash. Background Myelopathy is an uncommon complication of varicella-zoster virus (VZV) that is seen mostly in immunocompromised patients. The symptoms may also develop in the absence of rash. Design/Methods: Case 1: A 68-year-old healthy women was evaluated for 3-days of severe propioceptive ataxia, weakness in both limbs and sphincter dysfunction. During admission, she began to experience vivid, spontaneous and continuous sensation as whether her inferior half body were raising up in the air. Neurological examination revealed a thoracic C6-T4 sensory level associated with loss of sense position on movements in feet, ankles and hips, with mild lower limbs weakness. On the 4 day, she developed a left intercostal rash. Case 2: A 15 year-old boy with a 1-year history of RRMS, who has been treated with immunomodulators for 6 month, develops a left brachio-crural hemiparesis with ipsilateral decreased sensation in the trunk and limbs. This was interpreted as a new relapse, so he received intravenous glucocorticoids (GC). In the evolution, he developed a cutaneous rash in the left C8 metameres asociated with ipsilateral dysesthesias and arreflexic plegia in the upper limb. Results: In both patients, the MRI demonstrated an extended gadolinium cervico-thoracic medullar lesion. CSF analysis showed a mononuclear pleocitosis, elevated proteins, negative VZV PCR and elevated rate of anti-VZV IgG. Both were treated with acyclovir and GC. Conclusions: These two cases illustrate the broad clinical spectrum associated with VZV myelitis, which can occur in immunocompetent patients and in the absence of the characteristic metameric skin rash. Awareness of the diverse potential presentation of VZV myelitis is likely to lead to earlier treatment. Disclosure: Dr. Cuello has nothing to disclose. Dr. Rodriguez Cruz has nothing to disclose. Dr. de Orly has nothing to disclose. Dr. De Andres has nothing to disclose.