Sikarin Upala

Sikarin Upala

Columbia University College of Physicians and Surgeons, USA

Title: Varicella-zoster meningitis with a late-onset of skin eruption: a case report


Sikarin Upala completed his medical degree from Faculty of Medicine Siriraj Hospital, Mahidol University in 2012 and Master degree in nutrition and metabolic medicine from University of South Florida in 2013. He is currently an internal medicine resident at Bassett Medical Center, Cooperstown.


Viral meningitis caused by Varicella-zoster virus (VZV) is an uncommon neurological complication of herpes zoster. It may occur before or after the onset of the vesicular rash along the dermatomal distribution, which is the classic presentation of herpes zoster. Herein, we describe a 51-year-old immunocompetent man who presented with neck pain and severe right-sided facial pain. Eight days later, he had photophobia and papular rash on his forehead. Cerebrospinal fluid (CSF) examination confirmed aseptic meningitis and CSF polymerase chain reaction detected the presence of VZV DNA. Neurologic complications of VZV infection, such as aseptic meningitis, may be difficult to diagnose and cause delay in treatment, especially in cases with late onset of dermatologic manifestations of herpes zoster. Definite diagnosis requires evidence of acute VZV infection in blood or cerebrospinal fluid.