Xiaolin Wang1, Xu Zhang1, Zhe Yu1, Qiang Zhang2, Dehui Huang1, Shengyuan Yu3. 1. The PLA General Hospital, Department of Neurology, China. 2. The PLA General Hospital, Department of Orthopedic, China. 3. The PLA General Hospital, Department of Neurology, China. Electronic address: wangxl80@126.com.
Abstract
OBJECTIVE: To describe the clinical presentation and long-term disease outcomes of varicella zoster virus (VZV) infection-related myelitis (VZVM) in immunocompetent patients. METHOD: A series of 10 immunocompetent patients with VZVM were retrospectively observed and followed (3-96 months). RESULTS: The onset of myelitis was timed in relation to the appearance of VZV-associated rash (-3 to 50 days). Rash locations included the cervical (5), thoracic (2), and lumbar (3) dermatomes, whereas myelitis localized to the cervical (6) and thoracic (9) spinal cord and the medulla (1). Spinal MRI revealed extensive longitudinal transverse myelitis in nine patients, with multiple segmental lesions (≥2 segments) evident in five patients. Aquaporin-4, myelin oligodendrocyte glycoprotein, ganglioside Q1b, and ganglioside T1b antibodies were detected in some patients. Three patients fulfilled the 2015 diagnostic criteria for neuromyelitis optica spectrum disease, of whom two relapsed. Seven patients were treated with intravenous antivirals and methylprednisolone, with the remaining three patients receiving methylprednisolone only. Ongoing immunosuppressive therapy was provided for two patients who experienced relapses. To date, no patients have reported VZV reactivation. Over the course of follow-up, the Expanded Disability Status Scale (EDSS) score deceased from 4.9 to 2.6 on average. CONCLUSIONS: VZVM runs a relatively benign course in immunocompetent patients, although relapses can occur depending on patient immune status. A comprehensive evaluation of patient's autoimmune condition is recommended.
OBJECTIVE: To describe the clinical presentation and long-term disease outcomes of varicella zoster virus (VZV) infection-related myelitis (VZVM) in immunocompetent patients. METHOD: A series of 10 immunocompetent patients with VZVM were retrospectively observed and followed (3-96 months). RESULTS: The onset of myelitis was timed in relation to the appearance of VZV-associated rash (-3 to 50 days). Rash locations included the cervical (5), thoracic (2), and lumbar (3) dermatomes, whereas myelitis localized to the cervical (6) and thoracic (9) spinal cord and the medulla (1). Spinal MRI revealed extensive longitudinal transverse myelitis in nine patients, with multiple segmental lesions (≥2 segments) evident in five patients. Aquaporin-4, myelin oligodendrocyte glycoprotein, ganglioside Q1b, and ganglioside T1b antibodies were detected in some patients. Three patients fulfilled the 2015 diagnostic criteria for neuromyelitis optica spectrum disease, of whom two relapsed. Seven patients were treated with intravenous antivirals and methylprednisolone, with the remaining three patients receiving methylprednisolone only. Ongoing immunosuppressive therapy was provided for two patients who experienced relapses. To date, no patients have reported VZV reactivation. Over the course of follow-up, the Expanded Disability Status Scale (EDSS) score deceased from 4.9 to 2.6 on average. CONCLUSIONS: VZVM runs a relatively benign course in immunocompetent patients, although relapses can occur depending on patient immune status. A comprehensive evaluation of patient's autoimmune condition is recommended.
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