Varicella-Zoster Myelitis With Thoracic Demyelination and Lumbosacral Plexopathy in the Setting of Uncontrolled HIV

Varicella-zoster virus (VZV) myelitis is a rare but serious complication of VZV reactivation that can lead to significant neurological deficits. While antiviral therapy is the mainstay of treatment, the role of corticosteroids remains unclear. We present a case of a 30-year-old male who developed progressive asymmetric lower-extremity weakness, constipation, and urinary retention without a dermatomal rash in the setting of HIV/AIDS. MRI revealed longitudinally extensive transverse myelitis, and cerebrospinal fluid (CSF) analysis confirmed VZV reactivation. The patient was treated with ganciclovir and high-dose corticosteroids, leading to an initial neurological improvement. This case highlights the potential benefit of adjunctive corticosteroid therapy in reducing inflammation and improving outcomes in VZV myelitis. Given the lack of standardized treatment guidelines, further studies are needed to clarify the role of corticosteroids and optimize management strategies for this condition.