RESUMEN
Longitudinally extensive myelitis is a severe rare complication of varicella-zoster virus infection. We report a case in a 20-year-oldimmunocompetent patient who presented with a two-week history of lower-limb paresis and paresthesia below dermatome T12, andsphincter dysfunction. He presented with a zoster rash a week prior tothe onset of neurological symptoms. Spinal cord magnetic resonanceimaging revealed a C5-T12 intramedullary lesion and cerebrospinalfluid showed lymphocytic pleocytosis and elevated varicella-zostervirus immunoglobulin G. Patient had not gained much improvement after acyclovir and pulse therapy with methylprednisolone, which prompted a five-day course of plasmapheresis. He partially recovered, but remained with sphincter impairment.
Mielite longitudinalmente extensa é uma rara e grave complicação da infecção pelo vírus varicela-zóster. Relatamos o caso de um pacientede 20 anos de idade, imunocompetente, que há duas semanas apresentou paresia de membros inferiores e parestesias abaixo dodermátomo T12, associadas com disfunção esfincteriana. Ele apresentouum rash cutâneo sugestivo de herpes uma semana antes do início dos sintomas neurológicos. A ressonância magnética de medula espinhal demonstrou uma lesão intramedular de C5 a T12, e o líquido cerebroespinhal revelou uma pleocitose linfocítica com aumento de imunoglobulina IgG para o vírus varicela-zóster. O paciente não apresentou melhora após uso de aciclovir e pulsoterapia com metilprednisolona, o que motivou um curso de cinco dias de plasmaférese.Houve recuperação parcial, porém ele permaneceu com distúrbio esfincteriano.
Asunto(s)
Humanos , Masculino , Adulto , Adulto Joven , Herpesvirus Humano 3 , Mielitis/etiología , Mielitis/virología , Paresia/etiología , Médula Espinal/diagnóstico por imagen , Imagen por Resonancia MagnéticaRESUMEN
Listeria myelitis is known to be very rare and not reported yet in Korea. A 78-year-old man with diabetes mellitus and hepatocellular carcinoma presented altered mentality, paraparesis, and fever. His spinal cord MRI, cerebrospinal fluid study, and blood culture demonstrated thoracic myelitis caused by Listeria monocytogenes. This case suggests that listeria myelitis should be considered as one of the causes of non-tumorous myelopathy especially in immunocompromised patients.