A Case of Aseptic Meningitis Without Rash Possibly Associated With Varicella Vaccine

Varicella-zoster virus (VZV) may cause aseptic meningitis in the pediatric age group. We describe a pediatric case of aseptic meningitis with a substantial increase of the paired serum antibody to VZV in which the child did not have skin rash during the course of illness. The patient was a 13-year-o...

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Published inCurēus (Palo Alto, CA) Vol. 14; no. 5
Main Authors Aoki, Yoshihiro, Tanaka, Toshiyuki, Mizushiro, Naoto, Kitazawa, Katsuhiko
Format Journal Article
LanguageEnglish
Published Palo Alto Cureus Inc 26.05.2022
Cureus
Subjects
Antigens
Case reports
Chicken pox
Creatinine
Diagnostic tests
Encephalitis
Etiology
Glucose
Headaches
Infections
Infectious Disease
Magnetic resonance imaging
Meningitis
Neurology
Neutrophils
Patients
Pediatrics
Proteins
Severe acute respiratory syndrome coronavirus 2
Skin
Teenagers
Vaccines
Vomiting
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Summary:Varicella-zoster virus (VZV) may cause aseptic meningitis in the pediatric age group. We describe a pediatric case of aseptic meningitis with a substantial increase of the paired serum antibody to VZV in which the child did not have skin rash during the course of illness. The patient was a 13-year-old boy without any history of exposure to VZV who was admitted with headache, vomiting, and low-grade fever. He had received one dose of varicella vaccine derived from the Oka/Biken strain (vOka) at the age of one year. Cerebrospinal fluid (CSF) analysis on admission revealed an elevated white blood cell count at 609/mm3 with 99.6% mononuclear cells. As his symptoms resolved after lumbar puncture alone, he was discharged on the seventh day of hospitalization without receiving any specific medication. Serum VZV-IgG titer was found to be substantially elevated after two weeks. VZV infection and reactivations associated with vaccination, as well as past infections, should be included in the differential diagnoses of pediatric aseptic meningitis, even in the absence of skin rash in the entire course. Polymerase chain reaction (PCR) testing for VZV DNA in CSF should be performed in all cases, if available.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.25375