Treatment of Herpes Zoster-Associated Neurological Complications with High-Dose Intravenous Ascorbic Acid: Two Case Reports

Raushan Auezova,1 Assem Adirakhan,1 Kamila Mussabekova,1 Nurgul Aldiyarova,2 Serik Akshulakov,1 Lizette Auezova3 1Department of Pathology of the Central Nervous System, National Center for Neurosurgery, Astana, Kazakhstan; 2Professional Association of Clinical Pharmacologists and Pharmacists, Astana, Kazakhstan; 3Bioactive Molecules Research Group, Department of Chemistry and Biochemistry, Faculty of Sciences-II, Lebanese University, Beirut, LebanonCorrespondence: Lizette Auezova, Bioactive Molecules Research Group, Department of Chemistry and Biochemistry, Faculty of Sciences-II, Lebanese University, Fanar, Jdaidet el Matn, PO Box 90656, Beirut, Lebanon, Email [email protected]: Herpes zoster (HZ), caused by reactivation of the varicella zoster virus, can be associated with serious and difficult-to-treat neurological complications, especially in immunocompromised people. Ascorbic acid (Asc) administered intravenously in high doses has been shown to possess immunomodulatory and anti-inflammatory effects. Here, we report two cases of patients: 1) with postherpetic neuralgia (PHN) and 2) with myelitis presumably caused by HZ, who were successfully treated using this approach as adjunctive therapy. Regarding HZ-related myelitis, this is the first reported case to our knowledge.Cases Presentation: A 72-year-old male came to the clinic with treatment-resistant postherpetic trigeminal neuralgia and cervical sympathetic ganglionitis. He rated pain intensity as 10 on the visual analogue scale (VAS). The second patient, a 34-old female, was referred with a preliminary diagnosis of cervical myelitis. She suffered from right-sided sensory-motor impairments and urinary retention. Previous treatment did not result in improvement. Neurological and MRI findings were typical of cervico-thoracic myelitis associated with right-sided hemiparesis. Two months before the onset of the first symptoms, she developed a HZ rash in the cervico-occipital region on the right, suggesting an association between HZ and myelitis. Both patients received two courses of Asc (each course consisting of 20 g administered intravenously daily for five days). The male noted a gradual pain relief from the initial 10 to 2 points on the VAS, with only a slight increase at night. In the female’s case, hemiparesis regressed and bladder function was restored. Only mild neurological deficits remained.Conclusion: This study supports the use of high-dose intravenous Asc as adjunctive therapy for HZ-associated neuralgia and myelitis, especially in treatment-resistant cases. In order to determine the optimal dosages, it is necessary to perform clinical trials. Furthermore, it would be interesting to study the potential use of Asc therapy for other HZ-related complications.Keywords: varicella zoster virus, herpes zoster, myelitis, neuralgia, ascorbic acid