# Varicella-Zoster Myelitis With Thoracic Demyelination and Lumbosacral Plexopathy in the Setting of Uncontrolled HIV

## TL;DR

A rare case of VZV myelitis in an HIV patient showed improvement with corticosteroids, suggesting they may help reduce inflammation and improve outcomes.

## Contribution

This case study suggests corticosteroids may be beneficial in treating VZV myelitis, a finding not well established in current guidelines.

## Key findings

- MRI showed transverse myelitis and CSF analysis confirmed VZV reactivation in an HIV patient.
- Treatment with ganciclovir and corticosteroids led to initial neurological improvement.
- The case suggests corticosteroids may reduce inflammation and improve outcomes in VZV myelitis.

## Abstract

Varicella-zoster virus (VZV) myelitis is a rare but serious complication of VZV reactivation that can lead to significant neurological deficits. While antiviral therapy is the mainstay of treatment, the role of corticosteroids remains unclear. We present a case of a 30-year-old male who developed progressive asymmetric lower-extremity weakness, constipation, and urinary retention without a dermatomal rash in the setting of HIV/AIDS. MRI revealed longitudinally extensive transverse myelitis, and cerebrospinal fluid (CSF) analysis confirmed VZV reactivation. The patient was treated with ganciclovir and high-dose corticosteroids, leading to an initial neurological improvement. This case highlights the potential benefit of adjunctive corticosteroid therapy in reducing inflammation and improving outcomes in VZV myelitis. Given the lack of standardized treatment guidelines, further studies are needed to clarify the role of corticosteroids and optimize management strategies for this condition.