# A Case of Varicella Zoster Virus Meningoencephalitis With Generalized Chickenpox-Like Rash

## TL;DR

An elderly man with lung cancer developed VZV meningoencephalitis without initial skin rashes, highlighting the need to consider VZV in patients with acute cognitive decline.

## Contribution

This case emphasizes the importance of considering VZV in differential diagnoses even in the absence of skin eruptions.

## Key findings

- A 91-year-old man with lung cancer had VZV meningoencephalitis confirmed by CSF PCR.
- The absence of skin rashes initially complicated the diagnosis.
- MRI showed multiple small vessel lesions in the brain.

## Abstract

We report the case of a 91-year-old man with varicella zoster virus (VZV) meningoencephalitis who presented with acute progressive delirium. Brain MRI revealed multiple small vessel lesions, and cerebrospinal fluid testing came back positive for VZV DNA by polymerase chain reaction. We assume that VZV had reactivated since he was elderly and had lung cancer. The fact that there were no skin eruptions in the early stage made the diagnosis difficult. If a patient without skin rashes presents with acute progressive cognition, VZV should also be listed in the differential diagnosis.