Leukoencephalitis Due to Varicella Zoster Virus: Report of a Case and Review of Clinical Features

Steven C. Cramer, MD, Alan Segal, MD*, Ronald Hamilton, MD+, Jeremy Schmahmann, MD*, and M. Joe Ma, MD

Published: 14 May 1996

This case report describes the clinical features and postmortem diagnosis of varicella zoster virus (VZV) leukoencephalitis in a patient with acquired immunodeficiency syndrome (AIDS) who was taking suppressive doses of acyclovir for previous disseminated VZV infection. With more patients attaining increased survival in the later stages of AIDS, the incidence of VZV leukoencephalitis will likely rise. Because this is a treatable condition, clinical features of diagnostic value are reviewed. Key features include a history of deep, disseminated, or recurrent VZV infection; rapid progression; very low CD_4 count; and a tendency for hemorrhagic transformation on computed tomography (CT) of the head. The recurrence of VZV infection in a patient taking twice-daily oral acyclovir suggests that an alternate suppressive regimen may be needed after a severe VZV infection in an immunocompromised patient.

Keywords: VZV, leukoencephalitis, AIDS, hemmorrhage, acyclovir