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Case report
Varicella-zoster meningitis in an immunocompetent young man presenting with a painless erythematous rash
  1. Sahand Imani1,2,
  2. Natalie C Palavra1,2,
  3. Carly Oboudiyat1,2 and
  4. Jerome Ip1,2
  1. 1Department of Neurology, Sydney Adventist Hospital, Sydney, New South Wales, Australia
  2. 2Northern Sydney Local Health District, Sydney, New South Wales, Australia
  1. Correspondence to Dr Natalie C Palavra; Natalie.Palavra{at}


A 32-year-old man presented with a 7-day history of generalised headache, intermittent fever, emesis and diarrhoea. Four days after symptom onset, he developed a vesicular rash on his medial left thigh, without associated pain, paraesthesia or pruritus. He had no significant past medical history, and no HIV risk factors. He was presumed to have enteroviral meningitis and was commenced on supportive therapy. Lumbar puncture was performed and cerebrospinal fluid (CSF) analysis revealed a lymphocytic pleocytosis. While awaiting CSF serology, the formation of a new vesicle was noted at the site of the rash and was swabbed. Results for both the CSF and vesicle swab returned positive for varicella-zoster virus (VZV) confirming concurrent VZV meningitis with atypical painless herpes zoster in a young immunocompetent patient. He was initiated on intravenous acyclovir and made a full recovery after 2 weeks of treatment.

  • meningitis
  • infection (neurology)
  • general practice/family medicine
  • dermatology

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  • Contributors SI performed the literature search and prepared the manuscript. NCP, CO and JI critically reviewed the content and revised the manuscript. All authors were involved in the patient’s care.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.