VARICELLA-ZOSTER VIRUS MYELITIS - AN EXPANDING SPECTRUM
VARICELLA-ZOSTER VIRUS MYELITIS - AN EXPANDING SPECTRUM
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DOI：
10.1212/wnl.44.10.1818
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发表时间：
1994-10-01
期刊：
影响因子：
9.9
通讯作者：
MAHALINGAM, R
中科院分区：
文献类型：
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作者：
GILDEN, DH;BEINLICH, BR;MAHALINGAM, R
我们报告4例成人水痘-带状疱疹病毒（VZV）相关脊髓病。在两个显著的例子中，脊髓病是缓慢恶化的，一次是急性的，一次是慢性的。VZV脊髓病的诊断是基于皮疹与脊髓病发病之间的密切时间关系，并首次通过聚合酶链反应，在三名多细胞增多症患者的脑脊液中发现了VZV DNA。4例患者中有3例磁共振成像异常。虽然所有4例患者都曾接受过静脉注射阿昔洛韦的治疗，但同时接受类固醇治疗和其中1例患者出现获得性免疫缺陷综合征，使患者无法得出对治疗有良好反应的结论。VZV感染后的脊髓病除了急性或慢性外，还可缓解-加重。在出疹数月后脑脊液中检测VZV DNA有助于诊断，并提示病毒在脊髓病发病机制中的作用。
We report four cases of varicella-zoster virus (VZV)-associated myelopathy in adults. Myelopathy was remitting-exacerbating in two remarkable instances, once acute and once chronic. VZV myelopathy was diagnosed based on the close temporal relationship between rash and onset of myelopathy, and for the first time, by polymerase chain reaction, which revealed VZV DNA in the cerebral spinal fluid of three patients with pleocytosis weeks to months later. Magnetic resonance imaging was abnormal in three of four patients. Although all four patients were treated at some time with intravenous acyclovir, concomitant treatment with steroids and the presence of acquired immunodeficiency syndrome in one patient prevented conclusions about a favorable response to therapy. Myelopathy after VZV infection may be remitting-exacerbating in addition to acute or chronic. Detection of VZV DNA in cerebral spinal fluid months after rash was useful for diagnosis and suggests a role for virus in the pathogenesis of myelopathy.