A Case Report on Varicella zoster Encephalitis Vasculopathy

Varicella zoster virus (VZV) encephalopathy is a rare but serious complication of viral reactivation, particularly in immunocompromised individuals. We report the case of an 83- year-old female with a background of autoimmune hemolytic anemia and high-grade B-cell non-Hodgkin lymphoma, previously treated with immunotherapy and chemotherapy and was in complete remission who presented after 1 year with fever, altered mental status, and a generalized vesicular rash. MRI brain revealed T2/FLAIR parieto-occipital hyperintensities and multifocal infarcts suggestive of vasculopathy/acute infarct. Cerebrospinal fluid multiplex PCR confirmed the presence of VZV. The patient had profound hypogammaglobulinemia, and was treated with intravenous immunoglobulin. Despite best supportive management, her neurological condition rapidly deteriorated. This case underscores the importance of maintaining a high index of suspicion for VZV encephalopathy in elderly, immunocompromised patients presenting with encephalopathy and rash. Early CSF analysis and neuroimaging are essential for diagnosis, and timely diagnosis and aggressive management may influence the outcomes in such high-risk populations.