Title : Concurrence of chickenpox and varicella zoster virus encephalitis in an immunocompetent female: A case report
Abstract:
Background: Varicella-zoster virus (VZV) commonly causes chickenpox in childhood and may later reactivate as shingles. Neurological complications such as meningitis, encephalitis, and myelitis are more frequent in immunocompromised or elderly patients. VZV encephalitis is rare in immunocompetent individuals and carries significant morbidity and mortality if not promptly treated.
Case Description: We report a 44-year-old immunocompetent female who presented with high-grade fever and ageneralized papulovesicular rash typical of chickenpox. Five days after rash onset, she developedaltered sensorium, irritability, hallucinations, and generalized tonic-clonic seizures. Neurological examination revealed a Glasgow Coma Scale score of 7/15 with diminished tone and reflexes. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis consistent with viral encephalitis, and polymerase chain reaction confirmed VZV infection. MRI of the brain showed bilateral periventricular hyperintensities suggestive of small-vessel ischemic changes. She was treated with intravenous acyclovir for 14 days and a 5-day course of high-dose corticosteroids, along with anticonvulsants. Dramatic clinical improvement was observed, and the patient was discharged on day 15 with near-complete neurological recovery.
Discussion: This case highlights the occurrence of VZV encephalitis in an immunocompetent adult with active chickenpox. Although rare, clinicians should maintain a high index of suspicion for encephalitis in patients presenting with deteriorating consciousness or seizures during varicella infection. Early diagnosis with cerebrospinal fluid PCR and timely antiviral therapy are essential to reduce morbidity and prevent sequelae.
Conclusion: Varicella-related encephalitis can occur in immunocompetent patients. Prompt recognition and aggressive antiviral management can lead to favorable outcomes and avoid long-term neurological deficits.
Keywords: Varicella-zoster virus, Chickenpox, Encephalitis, Immunocompetent, Case report
