Recurrent Ischemic Strokes Due to Varicella-Zoster Virus (VZV) and Epstein-Barr Virus (EBV) Coinfection-Associated CNS Vasculitis in a Patient With AIDS: A Diagnostic and Therapeutic Challenge

We report an extremely rare case of CNS vasculitis caused by dual infection with varicella-zoster virus (VZV) and Epstein-Barr virus (EBV) in a man in his early 40s with newly diagnosed AIDS. He presented with seizures and encephalopathy, followed by recurrent multifocal strokes and MRI findings consistent with diffuse cerebral vasculitis. CSF analysis showed lymphocytic pleocytosis and tested positive for both VZV and EBV. Despite antiviral therapy and a brief course of corticosteroids, the patient experienced relapse and required retreatment. Clinical improvement was achieved with prolonged corticosteroid therapy combined with immune reconstitution via antiretroviral therapy. This case highlights the diagnostic challenges and potential for compounded vascular injury in dual herpesvirus CNS infection, emphasizing the importance of early recognition and the consideration of extended corticosteroid therapy in immunocompromised patients.