MENINGEAL IRRITATION AS A COMPLICATION OF HERPES-ZOSTER

History and clinical findings: A previously healthy 26-year-old man co mplained of gradually increasing headache after an attack of flu. Afte r 4 days an erythema with papules but no blisters was noted in the are a of distribution of the left 10th thoracic nerve. As a child he had h ad varicella (chickenpox) without complications. Investigations: Lymph ocytic pleocytosis and evidence of an abnormal blood-brain barrier wer e noted in cerebrospinal fluid (CSF). Serology for varicella tester vi rus revealed an IgG titre of > 7400 IU/l in serum and 21 IU/l in CSF. The corresponding IgM titres were negative. Treatment and course: The headaches and cutaneous changes regressed under i.v. treatment with ac yclovir, 10 mg/kg body weight, 3 x daily for 10 days. Repeat CSF exami nation after 10 days showed merely minimal residual changes of inflamm ation. Conclusion: This case illustrates the risk of severe neurologic al complications of herpes tester infection. A seemingly minor rash wi th headache must be correctly diagnosed and immediate high-dosage acyc lovir treatment instituted to prevent life-threatening and severe comp lications of herpes tester meningitis or encephalitis.