Recurrent polymorphonuclear pleocytosis with increased red blood cells caused by varicella zoster virus infection of the central nervous system: Case report and review of the literature

J Neurol Sci. 2010 May 15;292(1-2):85-8. doi: 10.1016/j.jns.2010.01.019. Epub 2010 Feb 19.


We describe an immunocompetent 45-year-old woman who had four episodes of neurological disease (meningoencephalitis, multifocal vasculopathy, myelitis and inflammatory brain stem disease) produced by varicella zoster virus (VZV) over an 11-month period, all in the absence of rash. The cerebrospinal fluid (CSF) contained anti-VZV IgG antibody, but not VZV DNA throughout her illness, reaffirming the superiority of detection of anti-VZV IgG in CSF compared to VZV DNA in diagnosing VZV infection of the nervous system. Moreover, 3 of 7 CSF samples examined during the 11 months showed a VZV-induced pleocytosis consisting predominantly of polymorphonuclear cells (PMNs), and 4 of 7 samples also contained increased numbers of red blood cells (RBCs). Because increased PMNs and RBCs in CSF can also occur in patients with central and peripheral nervous system disease produced by cytomegalovirus (CMV), the differential diagnosis of chronic nervous system infection with increased PMNs and RBCs in CSF should include analyses for both VZV and CMV.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Acyclovir / therapeutic use
  • Antiviral Agents / therapeutic use
  • Cell Count
  • Central Nervous System Infections / diagnosis
  • Central Nervous System Infections / drug therapy
  • Central Nervous System Infections / virology*
  • Erythrocytes / virology*
  • Female
  • Herpes Zoster / drug therapy
  • Herpes Zoster / virology*
  • Herpesvirus 3, Human
  • Humans
  • Leukocytosis / diagnosis
  • Leukocytosis / drug therapy
  • Leukocytosis / virology*
  • Magnetic Resonance Imaging
  • Middle Aged
  • Neutrophils / virology*
  • Recurrence
  • Treatment Outcome


  • Antiviral Agents
  • Acyclovir