ZOSTER MYELITIS - IMPROVEMENT WITH ANTIVIRAL THERAPY IN 2 CASES

This report describes two patients with acquired immunodeficiency synd rome (AIDS) and herpes tester myelopathy. Patient one had a T-8 myelit is that preceded the onset of T-8-distribution tester and was followed by cervical myelopathy. Antibody to varicella tester virus (VZV) was present in the CSF. He never received steroids or other immunosuppress ive drugs, and his condition improved dramatically after treatment wit h intravenous acyclovir. The second patient had a rapidly progressive myelitis with paralysis of both legs. Detection of VZV DNA and antibod y to VZV in his CSF led to successful treatment with famciclovir despi te discontinuation of dexamethasone and earlier treatment failure with acyclovir. These cases support the idea that VZV myelopathy in the im munosuppressed host is caused by virus invasion. CSF analysis for anti viral antibody and for VZV DNA by polymerase chain reaction are helpfu l in establishing the diagnosis. Aggressive antiviral therapy is advis ed.