valacyclovir and Cranial-Nerve-Diseases

A 64-year-old woman developed acute paralysis of glossopharyngeal, vagus, accessory, and hypoglossal nerves on the left side after pain in the head and the left ear and throat. Cerebrospinal fluid examination revealed lymphocytic pleocytosis and elevated protein concentration. Varicella-zoster virus (VZV)-DNA was detected by PCR from cerebrospinal fluid. The diagnosis of lower cranial polyneuropathy due to VZV reactivation was made. After oral administration of an anti-viral agent and steroid, all symptoms and signs dramatically improved. Notably, there was no evidence of cutaneous or mucosal rash during the whole course of the disease. VZV reactivation should be included in the differential diagnosis of acute lower cranial polyneuropathy, especially with pain in the ear and throat, even without cutaneous or mucosal rash.

Topics: Acyclovir; Administration, Oral; Antiviral Agents; Betamethasone; Biomarkers; Cranial Nerve Diseases; DNA, Viral; Drug Therapy, Combination; Ear; Female; Herpesvirus 3, Human; Humans; Middle Aged; Pain; Pharynx; Treatment Outcome; Valacyclovir; Valine; Zoster Sine Herpete

This report presents a case of infectious mononucleosis with severe neurological complications in a previously healthy young female. Both peripheral and cranial nerves were affected causing paralysis and need for assisted ventilation. There was a clear correlation between the symptoms and the serological findings, indicating that the causative agent was Epstein-Barr virus. The patient was treated with acyclovir, methylprednisolone and immunoglobulins. Two months later she had recovered completely. Epstein-Barr virus infection must be considered among the possible causes in patients with cranial nerve affection or Guillain-Barré syndrome.

Topics: Acyclovir; Adolescent; Anti-Inflammatory Agents; Antiviral Agents; Cranial Nerve Diseases; Epstein-Barr Virus Infections; Female; Guillain-Barre Syndrome; Humans; Immunoglobulins, Intravenous; Methylprednisolone; Valacyclovir; Valine