Article in Japanese

A case of zoster-associated meningitis in a healthy 14-year-old-boy and a literature review of zoster-associated meningitis cases in immunocompetent children in Japan

Naoko KITAJIMA¹⁾, Aya SHIMAUCHI¹⁾, Yoshinori ITO²⁾, Hiroshi KIMURA³⁾

A previously healthy 14-year-old boy suffered from severe headache, nausea and low-grade fever without rashes for three days, and admitted to our hospital. His illness was firstly diagnosed as aseptic meningitis. Three days after admission, a skin lesion of typical herpes zoster developed in the thoracic area. After the patient clinically received a diagnosis of zoster-associated meningitis, detection of the varicella-zoster virus (VZV) DNA in his cerebrospinal fluid, together with the skin lesion specimen, was confirmed. The effect of acyclovir was dramatic, and his symptoms resolved in just a few days. No long-term sequela developed.
This study reviewed the literature in the Japan Medical Abstracts Society (from 1987 to September 2017) on case reports of zoster-associated meningitis among immunologically healthy children, and found 22 cases in which early teenage boys were dominated. In addition, symptoms of meningitis preceded skin rashes, as our case, in more than half of the cases.
It has been reported that zoster associated with central nervous system (CNS) disease does not always present rashes. When examining a patient with CNS symptoms and a medical history of varicella, it is important to consider VZV as one of the causative agents, even in healthy children.
In Japan, VZV vaccine for infants has been introduced as national routine vaccination since 2014. It is expected that the epidemiology of varicella and zoster will change in Japan as other countries where the routine VZV vaccination started earlier. The importance of accurate diagnosis and investigation in the epidemiology of VZV related diseases would then increase more than ever before.

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1) Department of Pediatrics, Onga Nakama Medical Association Onga Hospital
2) Department of Pediatrics, Nagoya University Graduate School of Medicine
3) Department of Virology, Nagoya University Graduate School of Medicine

Key words	varicella-zoster virus(VZV), varicella-zoster, meningitis, acyclovir(ACV)
Received	July 9, 2018
Accepted	December 20, 2018

31 (1)：47─54,2019