CHRONIC VARICELLA-ZOSTER VIRUS MYELITIS WITHOUT CUTANEOUS ERUPTION INA PATIENT WITH AIDS - REPORT OF A FATAL CASE

We describe a fatal case of varicella-zoster virus myelitis that was p receded by neurological symptoms for 10 months in a patient with human immunodeficiency virus infection and an extremely low CD4 cell count (20/mu L). The patient was also receiving chronic acyclovir therapy fo r suppression of herpes simplex. Despite chronic unilateral periauricu lar and facial pain, which was later accompanied by upper- and lower-e xtremity weakness, a cutaneous eruption never developed. It is hypothe sized that a blunted inflammatory response in the spinal cord-possibly related to a very low CD4 cell count-and long-term acyclovir administ ration might have contributed to the atypical manifestation of varicel la-zoster virus-related neurological disease in this immunocompromised patient.