A Case of Varicella-zoster Virus Meningitis without Rash Diagnosed by Multiplex PCR

A healthy, immunocompetent 15-year-old girl was admitted to our hospital with headache, fever, and loss of consciousness after vomiting. The vomiting and consciousness disturbance improved promptly without any specific treatment. While there was meningism, due to the persistent headache and fever, a CSF examination was performed on the fourth day of admission, which revealed lymphocytic pleocytosis, and varicella-zoster virus (VZV) DNA was detected by Multiplex PCR. The patient gave a history of having had chickenpox at 4 years of age. She received a 14-day course of intravenous acyclovir, and the treatment was switched to oral valacyclovir, given for another 3 days. She made a full recovery, with no residual neurologic deficit. The frequency of VZV meningitis in children is low, and there have been reports of a few cases without skin rash. It is possible that some cases diagnosed as cases of aseptic meningitis without skin rash may be cases of VZV meningitis. Multiplex PCR testing is considered as being an important tool for early diagnosis and appropriate treatment.