ABSTRACT
We present a case of zoster sine herpete causing isolated acute dysphagia in an immunocompetent patient. The interest of this paper is the atypical presentation of varicella-zoster virus reactivation. A 77-year-old woman presented with a 3-day history of fever and worsening dysphagia for both liquid and solid foods. Cerebrospinal fluid examination revealed lymphocytic pleocytosis and PCR amplified varicella-zoster virus DNA with high antibody titers in both serum and cerebrospinal fluid. The panel was suggestive of a cranial neuritis due to varicella-zoster virus, involved cranial nerves, even in the absence of a cutaneous and mucosal rash. Varicella-zoster virus reactivation should be included in the differential diagnosis of isolated or multiple cranial nerve palsies, with or without zosteriform skin lesions. A prompt etiologic diagnosis can lead to early administration of antiviral therapy.
Subject(s)
Deglutition Disorders/diagnosis , Herpes Zoster/complications , Herpes Zoster/diagnosis , Herpesvirus 3, Human/isolation & purification , Neuritis/diagnosis , Aged , Antibodies, Viral/analysis , Antibodies, Viral/blood , Cerebrospinal Fluid/immunology , Cerebrospinal Fluid/virology , Deglutition Disorders/etiology , Deglutition Disorders/pathology , Female , Herpes Zoster/pathology , Herpes Zoster/virology , Herpesvirus 3, Human/physiology , Humans , Neuritis/etiology , Neuritis/pathology , Virus ActivationABSTRACT
Patients with myasthenia gravis and thymoma usually present antibodies to the acetylcholine receptor (AchR-Ab). Only two cases of thymoma-associated myasthenia gravis without AchR-Ab have been previously reported. We describe a case of seronegative thymoma-associated myasthenia gravis as a further evidence of the variability of myasthenia gravis in terms of antibody profile and thymic pathological findings.
