Due casi di encefalite da varicella zoster virus

The paper reports two cases of varicella-zoster virus (VZV) encephalitis in 11-year-old girls, one previously vaccinated and the other with a history of varicella. Both presented with headache, neck stiffness, vomiting, and vesicular rash; fever was absent in one case. Blood tests and brain CT were normal, while cerebrospinal fluid revealed hypoglycorrhachia, elevated protein and mononuclear pleocytosis. After initial empirical therapy with cefotaxime and acyclovir, the latter was continued alone for 14 days, with progressive clinical improvement. Brain MRI and immunological tests were normal; EEG abnormalities resolved at follow-up. Although uncommon, VZV is a relevant cause of meningoencephalitis in immunocompetent children, generally with a favourable prognosis. Rash may be absent in more than one-third of cases, and even the vaccine strain can reactivate, thus VZV must be considered in the differential diagnosis regardless of vaccination history or cutaneous findings.