acyclovir and Demyelinating-Diseases

Varicella zoster virus (VZV) encephalitis is associated with large or small vessel vasculopathy. We report the case of a 67-year-old woman with a history of non-Hodgkin's lymphoma and cancers of the breast and colon, who presented with a zosteriform rash and Brown-Sequard syndrome. Despite 10 days therapy with intravenous acyclovir, meningoencephalitis developed and the patient died 15 days after onset of neurological symptoms. Autopsy showed meningoencephalomyelitis with necrotising vasculitis of leptomeningeal vessels, which is a rare complication of VZV, and we review the literature of the nine similar published cases. Polymerase chain reaction of cerebrospinal fluid for VZV was negative 6 days after onset of neurological symptoms, but became positive by day 10. Only one multinucleated giant cell with intranuclear Cowdry type A inclusions was seen within an endothelial cell in a leptomeningeal vessel involved by vasculitis.

Topics: Acyclovir; Aged; Antiviral Agents; Brain; Demyelinating Diseases; DNA, Viral; Encephalitis, Viral; Fatal Outcome; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Meningoencephalitis; Polymerase Chain Reaction; Spinal Cord; Vasculitis, Central Nervous System

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adrenal Cortex Hormones; Capsaicin; Carbamazepine; Demyelinating Diseases; Ganciclovir; HIV-1; HTLV-I Infections; Humans; Muscular Diseases; Neuritis; Neuromuscular Diseases; Peripheral Nervous System Diseases; Polyneuropathies; Zidovudine

VZV virus-related peripheral neuropathies usually occur after shingles in adults and more rarely after chickenpox in childhood.. A 54-year-old patient presented with a right VIIth nerve palsy following a chickenpox rash and recovered after antiviral treatment. CSF analysis revealed lymphocytic meningitis and the virus was identified by PCR.. Although previous chickenpox was not found in the patient's past history, the probability of reinfection is likely. The virus can be assumed to affect the nervous system directly; the axonal or demyelinating mechanism of the neuropathy may be discussed.

Topics: Acyclovir; Antiviral Agents; Chickenpox; Demyelinating Diseases; Facial Nerve Diseases; Facial Paralysis; Herpesvirus 3, Human; Humans; Male; Meningitis; Middle Aged

Herpes simplex virus (HSV) is regarded as an agent that selectively affects temporal and frontal lobes with necrosis and hemorrhage, and no case of herpes simplex encephalitis (HSE) with white matter lesion in a diffuse fashion has previously been reported. A 2-year-old boy developed high fever, right hemi-convulsions and lethargy. Computed tomography (CT) showed wedge-shaped areas of high density in the left frontal region, whereas, cerebral angiography disclosed no vascular abnormality. T1-weighted magnetic resonance imaging (MRI) demonstrated cortical changes which were similar to those illustrated by CT. However, T2-weighted images depicted further spread high intensities of the lesion. The patient's symptoms spontaneously disappeared before an antiviral drug, acyclovir, was administered. After the significant increase of HSV antibody titers in serum and cerebro-spinal fluid (CSF) established a definite diagnosis, acyclovir was intravenously given at a daily dosage of 30 mg/kg for a period of 6 days in order to prevent the recurrence of HSE. Two months later, T2-weighted MRI visualized a diffuse lesion of increased signal intensities involving the white matter of both hemispheres, while both CSF protein and myelin basic protein were significantly elevated. Despite of these changes of the white matter, our patient developed a few symptoms such as mild speech disturbance, slight weakness of the right upper limb and sialorrhea. Although the mechanism of these changes in the white matter remains obscure, it is postulated that a direct invasion of HSV to the white matter, an immunological disorder following HSV infection and a side effect of acyclovir could have triggered a reversible process of demyelination of the cerebral white matter.

Topics: Acyclovir; Cerebral Cortex; Child, Preschool; Demyelinating Diseases; Encephalitis; Herpes Simplex; Humans; Magnetic Resonance Imaging; Male; Tomography, X-Ray Computed

Topics: Acyclovir; Animals; Antiviral Agents; Creutzfeldt-Jakob Syndrome; Demyelinating Diseases; Encephalitis; Encephalomyelitis; Guanine; Herpes Simplex; Humans; Nervous System Diseases; Polyradiculoneuropathy; Reye Syndrome; Vidarabine; Virus Diseases