Herpes zoster ophthalmicus and varicella zoster meningoencephalitis in a newly diagnosed case of retroviral disease: a case report

BackgroundMeningoencephalitis and herpes zoster ophthalmicus (HZO) are rare neurological and ocular complications of herpes zoster, respectively. Their co-occurrence is rarer, even in patients with retroviral disease (RVD), and may occur in the presence of normal CD4 count.Case presentationA 35-year-old woman presented with altered sensorium. Four days back, she developed left-sided severe, deep burning type headache, and on the next day, painful vesicles developed over the left side of the scalp which progressively involved the forehead, upper part of left cheek, and tip of the nose, with swelling around the eyes. Ophthalmic examination revealed conjunctivitis and keratitis suggesting acute HZO. Neck rigidity was present, and MRI brain was suggestive of acute meningoencephalitis. The DNA polymerase chain reaction of cerebrospinal fluid for varicella zoster virus (VZV) confirmed the diagnosis of acute meningoencephalitis. The search for cause of immunosuppression led to the diagnosis of RVD. Treatment with intravenous acyclovir and dexamethasone led to rapid recovery and clearing of lesions.ConclusionVZV infection should be included in the differential diagnosis among patients with newly diagnosed RVD presenting with meningoencephalitis and HZO.