acyclovir and Brachial-Plexus-Neuritis

Topics: Acyclovir; Aged; Anti-Inflammatory Agents, Non-Steroidal; Antiviral Agents; Brachial Plexus Neuritis; Electromyography; Herpes Zoster; Humans; Male; Physical Therapy Modalities; Shoulder Pain

Varicella zoster virus (VZV) infection sometimes result in visceral disseminated VZV infection (VD-VZV), which is a fulminant disease featured by abdominal pain and the absence of skin lesions, particularly occurs in the immunosuppressive patients. Brachial plexus neuritis (BPN) is another rare type of VZV infection usually appears without blisters. Few diagnostic images of both VD-VZV and BPN-VZV have been reported. A 25-year-old woman receiving allogeneic hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia. Unexplained severe pain in the left upper extremity followed by severe stomachache, liver dysfunction and unconsciousness appeared on day 344 post-HSCT. Computed tomography (CT) showed left brachial plexus hypertrophy and edematous changes to the hepatoduodenal ligament, fluorodeoxyglucose positron emission tomography (FDG-PET) showed increased uptake in both lesions. Intravenous acyclovir therapy was started and successfully resolved all symptoms. Several days later, blisters appeared all over the body and positive VZV DNA from blood using polymerase chain reaction test was obtained. FDG-PET and CT may offer supportive findings for detecting or diagnosing blister-less VZV infectious diseases.

Topics: Acyclovir; Administration, Intravenous; Adult; Antiviral Agents; Brachial Plexus; Brachial Plexus Neuritis; Female; Fluorodeoxyglucose F18; Hematopoietic Stem Cell Transplantation; Herpesvirus 3, Human; Humans; Leukemia, Myeloid, Acute; Positron-Emission Tomography; Radiopharmaceuticals; Tomography, X-Ray Computed; Transplantation, Homologous; Treatment Outcome; Varicella Zoster Virus Infection

Topics: Acyclovir; Antiviral Agents; Brachial Plexus Neuritis; Female; Herpes Zoster; Humans; Middle Aged; Paresis

We present the case of a 48-year-old HIV-positive man, who developed acute onset of pain in both upper limbs associated with proximal weakness and distal paraesthesia. Eight weeks prior to this presentation he had had varicella zoster affecting his right S1 dermatome. CD4 count was 355 cells/mm(3) and he was antiretroviral therapy (ART) naive. Power was 0/5 proximally and 4/5 distally in the upper limbs. Reflexes were absent and there was sensory loss in the C5, C6 and T1 dermatomes. Cerebrospinal fluid (CSF) examination showed a lymphocytosis with low glucose; however, CSF Mycobacterium tuberculosis (TB), and herpes simplex virus polymerase chain reaction (HSV PCR) were negative as was syphilis serology. Electromyography showed marked motor axonal loss. Magnetic resonance imaging (MRI) did not show any cervical spinal lesion. Varicella zoster virus (VZV) PCR was positive in the CSF. He was treated with high-dose intravenous aciclovir with good resolution of his syndrome over time and was commenced on ART. We believe this to be the first case report of varicella reactivation causing bilateral neuralgic amyotrophy in an HIV-positive patient.

Topics: Acyclovir; Antiviral Agents; Brachial Plexus Neuritis; Chickenpox; Herpesvirus 3, Human; HIV Infections; Humans; Male; Middle Aged; Virus Activation