Herpes Zoster Radiculomyelitis With Aquaporin-4 Antibodies: A Case Report and Literature Review.

Abstract:

:Background: The relationship between varicella-zoster virus (VZV)-associated myelitis and aquaporin-4 immunoglobulin-G (AQP4-IgG) remains unknown. Case Report: We report a case of acute radiculomyelitis with longitudinal extensive hyperintensity signals traversing the brainstem until the upper thoracic cord in a 55-year-old healthy woman following herpes zoster infection in the left C4-T3 dermatome. VZV-specific IgG in the cerebrospinal fluid (CSF) and AQP4-IgG positivity on enzyme-linked immunosorbent assay (ELISA) were undetectable. Thus, she was diagnosed with immune-competent VZV radiculomyelitis. Forty-two months later, she experienced a relapse, and AQP4-IgG positivity was detected on ELISA. A cell-based assay (CBA) showed AQP4-IgG positivity not only at the time of recurrence but also retrospectively at 1 month after the initial symptoms. We concluded that AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) was concurrent with VZV myelitis. After the second attack, she was treated with azathioprine and has had no relapse since then. Conclusion: We reported a case of VZV radiculomyelitis with confirmed concurrent AQP4-IgG positivity. NMOSD induced by herpes zoster has been recently identified, but distinguishing it from VZV myelitis can be difficult and whether these two diseases aggravate each other is unknown. Awareness of the potentially varied presentation of VZV myelitis can enable earlier recognition and proper treatment.

journal_name

Front Neurol

journal_title

Frontiers in neurology

authors

Eguchi H,Takeshige H,Nakajima S,Kanou M,Nakajima A,Fuse A,Fukae J,Miwa H,Shimo Y

doi

10.3389/fneur.2020.585303

subject

Has Abstract

pub_date

2020-11-23 00:00:00

pages

585303

issn

1664-2295

journal_volume

11

pub_type

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    更新日期:2017-06-30 00:00:00

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    更新日期:2019-05-21 00:00:00

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    doi:10.3389/fneur.2020.00089

    authors: Alshamrani F,Alnajashi H,Shosha E,Casserly C,Morrow SA

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    pub_type: 杂志文章

    doi:10.3389/fneur.2019.01307

    authors: Sartoretti E,Sartoretti T,Wyss M,Becker AS,Schwenk Á,van Smoorenburg L,Najafi A,Binkert C,Thoeny HC,Zhou J,Jiang S,Graf N,Czell D,Sartoretti-Schefer S,Reischauer C

    更新日期:2019-12-10 00:00:00

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    pub_type: 杂志文章

    doi:10.3389/fneur.2020.584479

    authors: Kawasaki A,Udry M,El Wardani M,Münch M

    更新日期:2021-01-15 00:00:00