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Case report
Disseminated herpes zoster with acute encephalitis in an immunocompetent elderly man
  1. Jessica Hyejin Oh1,
  2. Saketh Tummala2 and
  3. Muhammad Ghazanfar Husnain2
  1. 1Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  2. 2Department of Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  1. Correspondence to Dr Muhammad Ghazanfar Husnain; husnainmg82{at}


Varicella-zoster virus (VZV) encephalitis typically occurs in immunosuppressed populations such as in patients with HIV/AIDS, transplantation and autoimmune disease. However, it can also occur in healthy hosts. We present the case of an immunocompetent patient who presented with a clinical picture of VZV encephalitis with the sole precipitating factor of advanced age. We want to stress the importance of including VZV in the differential diagnosis for encephalitis in healthy elderly hosts. In patients with a clinical diagnosis of encephalitis, the presence of herpes zoster rash increases the likelihood of VZV encephalitis. However, the absence of a skin rash may not exclude the diagnosis. In general, there is an elevated risk of transient ischaemic attack and stroke associated with the diagnosis of herpes zoster infection. Early treatment is essential to prevent complications, including death.

  • infectious diseases
  • infections
  • infection (neurology)

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  • Contributors All authors were involved in the direct care of the patient and conceived the idea of writing a case report. JHO and ST wrote the case presentation, performed a literature review, and wrote the discussion of the manuscript. MGH substantially reviewed and edited the whole manuscript for important intellectual content. All authors read the final manuscript and approved it for submission in its current form.

  • 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 Next of kin consent obtained.

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