VARICELLA-ZOSTER VIRUS MYELITIS WITHOUT S KIN-LESIONS - POSSIBLE CAUSE OF THE RADICULAR SYNDROME

History and clinical findings: A 43-year-old woman was admitted with a 14-day history of general malaise, subfebrile temperature, radicular dysaesthesias in the >>riding breeches<< area, severe pain in the lumb ar region and progressive disorders of bladder and rectal emptying. Ph ysical examination showed a conus-cauda syndrome. Differential diagnos is was between myelitis (inflammatory or infectious), space-occupying intraspinal mass or vascular lesion. Investigations: Cerebrospinal flu id contained 1700/3 cells and there was intrathecal antibody synthesis against varicella tester virus (VZV) and positive VZV-DNA analysis in the polymerase chain reaction. Magnetic resonance imaging of the lumb ar spine revealed an inflamed enlarged conal and epiconal area with sm all haemorrhagic spots. There was no evidence of an underlying immune- modulated disease. Treatment and course: With the diagnosis of varicel la tester myelitis with cutaneous changes having been established the clinical signs and symptoms regressed almost completely with aciclovir administration (10mg/kg intravenously for 14 days). Conclusion: VZV w ithout cutaneous involvement should be considered in the differential diagnosis of the radicular pain syndrome. When clinical signs of begin ning myelitis or encephalitis are present, immediate investigations an d therapy are necessary.