J Korean Med Sci.  2022 Feb;37(8):e61. 10.3346/jkms.2022.37.e61.

A Case Report of Varicella Zoster Meningitis as Co-Infection With Breakthrough COVID-19 in an Immunocompetent Patient

• Yun S
• Kim J
• Shin HR

• KMID: 2526796
• DOI: http://doi.org/10.3346/jkms.2022.37.e61

Abstract

There are several previous reports that infection or reactivation of varicella zoster virus (VZV) can occur after coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Herein, we report a rare case of VZV meningitis in breakthrough COVID-19. An 18-years-old male visited the emergency room, presenting with a headache and fever of up to 38.4°C for 5 days. He received the second dose of BNT162b2 mRNA SARS-CoV-2 vaccine 7 weeks prior to symptom onset. The symptoms persisted with headache, fever, and nausea. His cerebrospinal fluid (CSF) showed an elevated opening pressure of 27 cm H₂O, 6/µL red blood cells, 234/µL white blood cells polymorphonuclear leukocytes 3%, lymphocytes 83%, and other 14%), 43.9 mg/dL protein, and 59 mg/dL glucose, and CSF polymerase chain reaction (PCR) test was positive for VZV. Also, he was diagnosed with COVID-19 by reverse transcriptase-PCR examining upper and lower respiratory tract. We administered intravenous acyclovir for 12 days, and he was discharged without any neurologic complication.

Keyword

COVID-19; SARS-CoV-2; Varicella-Zoster Virus; Meningitis

Figure

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  Fig. 1 Clinical course of the patient. We described the major symptoms (headache and fever) and test results of the patient. He presented 5 days of headache and 4 days of fever at the admission. The initial CSF study showed positive PCR for VZV. Reverse transcriptase-PCR for SARS-CoV-2 were persistently positive during the admission. The follow-up CSF analyses at day 10 turned out to be negative PCR for VZV.SARS-CoV-2 = severe acute respiratory syndrome coronavirus-2, PCR = polymerase chain reaction, CSF = cerebrospinal fluid, WBC = white blood cell, VZV = varicella zoster virus, ER = emergency room.

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