[A case of adult-onset varicella pneumonia and varicella-zoster virus (VZV) meningitis resulting from a reoccurrence of varicella].

The patient was a 74-year old male who presented with a skin rash, cough, and impaired consciousness. A diffuse, systemic, dark red rash was observed and he was admitted. Varicella infection was diagnosed based on the varicella-zoster virus (VZV)-IgM levels. The extremely high VZV- IgG levels observed were unlikely to be present in an initial infection and the infection was thought to be a reoccurrence. Diffuse nodular shadows measuring < or = 5 mm in diameter were observed on chest computed tomography (CT);this was consistent with the typical imaging findings of varicella pneumonia. The cerebrospinal fluid (CSF) was positive for CSF VZV-IgM antibody, CSF VZV-PCR, and CSF antibody titer index. A diagnosis of varicella meningitis was made. When both respiratory and neurological symptoms are observed in patients with varicella infection, it is necessary to consider a combined diagnosis of varicella pneumonia and varicella meningitis/encephalitis and perform chest imaging and a CSF examination. Repeated asymptomatic re-infection is considered necessary in order to maintain a lifelong immunity to varicella; however, the opportunities for asymptomatic re-infection are decreasing with the declining birth rate and trend toward small families. As a result, reoccurrences of varicella infection in the elderly are expected to increase with rapidly increasing longevity.