Acute, chronic, and recurrent varicella zoster virus neuropathy without zoster rash

The authors report three patients with acute, chronic, and recurrent neurop athy associated with varicella tester virus (VZV) infection but without tes ter rash. CSF of all three patients contained VZV immunoglobulin G antibody , but not herpes simplex virus. In two patients, serum/CSF ratios of VZV im munoglobulin G were reduced compared to normal ratios for immunoglobulin G and albumin, and one patient also had VZV immunoglobulin M in CSF. All thre e patients received antiviral therapy and improved. The diagnosis of nervou s system infection by VZV may be confirmed by the presence of antibody to V ZV in CSF even without detectable VZV DNA.