Varicella-Zoster Virus Infection in an Immunocompromised Patient With Seizure-Like Activity and Septic Shock: A Case Report

TL;DR

A man with AIDS developed severe symptoms including seizures and septic shock due to a rare reactivation of the varicella-zoster virus in his central nervous system.

Contribution

This case report highlights a rare and severe manifestation of VZV reactivation in an immunocompromised patient.

Findings

The patient presented with fevers, seizure-like activity, and septic shock due to VZV infection.

VZV was detected through lumbar puncture in the emergency department.

The case emphasizes the need for emergency physicians to consider rare VZV complications in immunocompromised individuals.

Abstract

Varicella-zoster virus (VZV) is well-known for causing primary chickenpox infection; however, it remains dormant in the central nervous system and can be reactivated during periods of decreased cell-mediated immunity. In addition to shingles, which is the most common form of reactivation, other rare secondary complications have been observed, including meningitis and encephalitis. Immunocompromised patients, such as those with acquired immunodeficiency syndrome (AIDS), are at an increased risk of such complications. We present the case of a 58-year-old male with AIDS (CD4 111 cells/mm3) who developed fevers, seizure-like activity, and septic shock. A lumbar puncture performed in the emergency department found the patient to have VZV infection. This case underscores a rare but devastating diagnosis that emergency physicians should be aware of.

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