# Zoster sine herpete complicated by central nervous system infection in an immunocompetent adult: A case report

## TL;DR

A 40-year-old immunocompetent woman developed VZV meningitis without a rash, highlighting the importance of recognizing rare zoster sine herpete cases.

## Contribution

This case report documents a rare instance of zoster sine herpete complicated by central nervous system infection in an immunocompetent adult.

## Key findings

- VZV meningitis was diagnosed via cerebrospinal fluid PCR despite absence of rash.
- The patient required 21 days of intravenous acyclovir therapy.
- The case underscores the need for heightened clinical suspicion in atypical VZV presentations.

## Abstract

Varicella zoster virus (VZV) reactivation can occur without the characteristic rash, a condition known as zoster sine herpete (ZSH). This case report highlights a rare presentation of VZV reactivation.

Case presentation: We present the case of a 40-year-old immunocompetent woman with a five-day history of headache, followed by neuropathic dermatomal pain localized to the left C2–C3 dermatomes. Cerebrospinal fluid analysis demonstrated a positive polymerase chain reaction (PCR) for VZV, confirming a diagnosis of ZSH complicated by VZV meningitis.

Discussion: The patient’s condition necessitated intravenous acyclovir therapy for 21 days. VZV meningitis can lead to severe outcomes, highlighting the importance of prompt diagnosis and timely treatment to prevent complications. The absence of a rash in ZSH necessitates heightened clinical suspicion to avoid potentially life-threatening consequences of VZV reactivation.

Early recognition and prompt intervention are crucial for managing ZSH and preventing severe complications such as VZV meningitis, highlighting the importance of clinical awareness of atypical presentations of VZV reactivation among healthcare providers.