This post is an answer to the Case – Pruritic Rash in a Woman with HIV
A skin biopsy sample stained positive for varicella zoster virus (VZV), but negative for herpes simplex virus (HSV). Zoster-associated encephalitis from disseminated VZV can develop within days of the disseminated rash, and should be strongly suspected in immunosuppressed patients.
Characteristic signs of zoster-associated encephalitis include acute delirium, typical signs of stroke such as headache with acute hemiplegia, aphasia, ataxia, hemisensory loss, or visual changes, dependent on the predominant location of the VZV vasculitis.
Intravenous aciclovir 10 mg/kg every 8 h for 7–10 days should be started early if there is clinical suspicion of encephalitis. Our patient was given intravenous aciclovir and multiple antiepileptic drugs to control her seizures. We treated her for VZV pneumonia, aspergillus pneumonia, propofol-induced pancreatitis, Escherichia coli urinary tract infection, and critical illness myopathy. After stabilisation in hospital she was started on antiretrovirals and pneumocystis pneumonia prophylaxis.
After 2 months of rehabilitation she could walk independently and communicate without difficulty. At last follow-up, she had made a near full recovery in terms of her cognitive and motor function.
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