{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T20:35:41Z","timestamp":1773779741026,"version":"3.50.1"},"reference-count":48,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,5,12]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:p>Varicella-zoster virus (VZV) encephalitis typically occurs in immunosuppressed populations such as in patients with HIV\/AIDS, transplantation and autoimmune disease. However, it can also occur in healthy hosts. We present the case of an immunocompetent patient who presented with a clinical picture of VZV encephalitis with the sole precipitating factor of advanced age. We want to stress the importance of including VZV in the differential diagnosis for encephalitis in healthy elderly hosts. In patients with a clinical diagnosis of encephalitis, the presence of herpes zoster rash increases the likelihood of VZV encephalitis. However, the absence of a skin rash may not exclude the diagnosis. In general, there is an elevated risk of transient ischaemic attack and stroke associated with the diagnosis of herpes zoster infection. Early treatment is essential to prevent complications, including death.<\/jats:p>","DOI":"10.1136\/bcr-2019-232928","type":"journal-article","created":{"date-parts":[[2020,6,25]],"date-time":"2020-06-25T05:34:45Z","timestamp":1593063285000},"page":"e232928","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":6,"title":["Disseminated herpes zoster with acute encephalitis in an immunocompetent elderly man"],"prefix":"10.1136","volume":"13","author":[{"given":"Jessica Hyejin","family":"Oh","sequence":"first","affiliation":[{"name":"Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Saketh","family":"Tummala","sequence":"additional","affiliation":[{"name":"Department of Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad Ghazanfar","family":"Husnain","sequence":"additional","affiliation":[{"name":"Department of Medicine, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,6,24]]},"reference":[{"key":"2025082711432930000_13.6.e232928.1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp013211"},{"key":"2025082711432930000_13.6.e232928.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03705.x"},{"key":"2025082711432930000_13.6.e232928.3","doi-asserted-by":"crossref","DOI":"10.3390\/v10110609","article-title":"Clinical features of varicella-zoster virus infection","volume":"10","author":"Kennedy","year":"2018","journal-title":"Viruses"},{"key":"2025082711432930000_13.6.e232928.4","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1128\/CMR.9.3.361","article-title":"Varicella-Zoster virus","volume":"9","author":"Arvin","year":"1996","journal-title":"Clin Microbiol Rev"},{"key":"2025082711432930000_13.6.e232928.5","doi-asserted-by":"publisher","DOI":"10.1016\/S0046-8177(96)90220-8"},{"key":"2025082711432930000_13.6.e232928.6","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1016\/j.medmal.2017.02.003","article-title":"Epidemiology of infectious encephalitis causes in 2016","volume":"47","author":"Boucher","year":"2017","journal-title":"Med Mal Infect"},{"key":"2025082711432930000_13.6.e232928.7","doi-asserted-by":"crossref","unstructured":"Ellis DL-A , Barsell A , Riahi RR , et al . Varicella zoster virus encephalitis in a patient with disseminated herpes zoster: report and review of the literature. Dermatol Online J 2014;21. [Epub ahead of print: 14 Dec 2014].","DOI":"10.5070\/D3213022994"},{"key":"2025082711432930000_13.6.e232928.8","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-015-0867-6"},{"key":"2025082711432930000_13.6.e232928.9","doi-asserted-by":"publisher","DOI":"10.1086\/513754"},{"key":"2025082711432930000_13.6.e232928.10","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0104169"},{"key":"2025082711432930000_13.6.e232928.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(02)00021-7"},{"key":"2025082711432930000_13.6.e232928.12","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(09)70134-6"},{"key":"2025082711432930000_13.6.e232928.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0206163","article-title":"Association of herpesviruses and stroke: systematic review and meta-analysis","volume":"13","author":"Forbes","year":"2018","journal-title":"PLoS One"},{"key":"2025082711432930000_13.6.e232928.14","doi-asserted-by":"crossref","DOI":"10.3390\/jcm8040547","article-title":"Does herpes zoster increase the risk of stroke and myocardial infarction? A comprehensive review","volume":"8","author":"Wu","year":"2019","journal-title":"J Clin Med"},{"key":"2025082711432930000_13.6.e232928.15","doi-asserted-by":"crossref","first-page":"763","DOI":"10.1016\/j.mayocp.2018.12.025","article-title":"Analysis of vascular event risk after herpes zoster from 2007 to 2014 us insurance claims data","volume":"94","author":"Patterson","year":"2019","journal-title":"Mayo Clin Proc"},{"key":"2025082711432930000_13.6.e232928.16","doi-asserted-by":"crossref","first-page":"436","DOI":"10.1016\/j.neurol.2019.07.009","article-title":"Management of infectious encephalitis in adults: highlights from the French guidelines (short version)","volume":"175","author":"Martinez-Almoyna","year":"2019","journal-title":"Rev Neurol"},{"key":"2025082711432930000_13.6.e232928.17","doi-asserted-by":"publisher","DOI":"10.1172\/JCI92280"},{"key":"2025082711432930000_13.6.e232928.18","doi-asserted-by":"publisher","DOI":"10.1212\/NXI.0000000000000500"},{"key":"2025082711432930000_13.6.e232928.19","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1089\/apc.1998.12.61","article-title":"Hiv\/Aids case histories: diagnostic problems. varicella-zoster encephalitis.","volume":"12","author":"Edgar","year":"1998","journal-title":"AIDS Patient Care STDS"},{"key":"2025082711432930000_13.6.e232928.20","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-510X(98)00153-1"},{"key":"2025082711432930000_13.6.e232928.21","first-page":"43","article-title":"A case of herpes zoster encephalitis with Ramsay-Hunt syndrome, herpes zoster generalisatus and acute pancreatitis","volume":"52","author":"Nakane","year":"2000","journal-title":"No To Shinkei"},{"key":"2025082711432930000_13.6.e232928.22","doi-asserted-by":"publisher","DOI":"10.1080\/00313020120105705"},{"key":"2025082711432930000_13.6.e232928.23","doi-asserted-by":"crossref","first-page":"255","DOI":"10.1590\/S1413-86702004000300010","article-title":"Varicella-Zoster virus encephalitis in an AIDS patient","volume":"8","author":"Toledo","year":"2004","journal-title":"Braz J Infect Dis"},{"key":"2025082711432930000_13.6.e232928.24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-0012.2005.00382.x"},{"key":"2025082711432930000_13.6.e232928.25","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1532\/IJH97.06044","article-title":"Varicella-Zoster virus encephalitis in a patient undergoing unrelated cord blood transplantation for myelodysplastic syndrome-overt leukemia","volume":"84","author":"Fukuno","year":"2006","journal-title":"Int J Hematol"},{"key":"2025082711432930000_13.6.e232928.26","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1080\/08860220601166602","article-title":"Varicella-Zoster infection with encephalopathy, pneumonia, and renal failure: a case report","volume":"29","author":"Chuang","year":"2007","journal-title":"Ren Fail"},{"key":"2025082711432930000_13.6.e232928.27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-4632.2008.04023.x"},{"key":"2025082711432930000_13.6.e232928.28","doi-asserted-by":"publisher","DOI":"10.1002\/lary.20111"},{"key":"2025082711432930000_13.6.e232928.29","first-page":"271","article-title":"Varicella zoster virus encephalitis during treatment with anti-tumor necrosis factor-alpha agent in a psoriatic arthritis patient","volume":"33","author":"Buccoliero","year":"2010","journal-title":"New Microbiol"},{"key":"2025082711432930000_13.6.e232928.30","doi-asserted-by":"crossref","first-page":"631","DOI":"10.3109\/00365540903510716","article-title":"Varicella-Zoster virus meningoencephalitis in an immunocompetent patient without a rash","volume":"42","author":"Klein","year":"2010","journal-title":"Scand J Infect Dis"},{"key":"2025082711432930000_13.6.e232928.31","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.hrtlng.2010.05.059","article-title":"Facial herpes zoster complicated by varicella zoster virus (VZV) encephalitis: the diagnostic significance of atypical lymphocytes in cerebrospinal fluid (CSF)","volume":"40","author":"Cunha","year":"2011","journal-title":"Heart Lung"},{"key":"2025082711432930000_13.6.e232928.32","doi-asserted-by":"crossref","unstructured":"Kangath RV . BMJ Case Rep 2013.","DOI":"10.1136\/bcr-2013-008592"},{"key":"2025082711432930000_13.6.e232928.33","first-page":"54","volume":"9(1","author":"Elwir","year":"2013","journal-title":"Gastroenterol Hepatol"},{"key":"2025082711432930000_13.6.e232928.34","doi-asserted-by":"crossref","DOI":"10.1186\/1752-1947-7-155","article-title":"Herpes zoster encephalitis presenting as multiple cerebral hemorrhages - a rare presentation: a case report","volume":"7","author":"Saxena","year":"2013","journal-title":"J Med Case Rep"},{"key":"2025082711432930000_13.6.e232928.35","doi-asserted-by":"crossref","first-page":"687.e5","DOI":"10.1016\/j.ajem.2013.12.019","volume":"32(6","author":"Alonso","year":"2014","journal-title":"Am J Emerg Med"},{"key":"2025082711432930000_13.6.e232928.36","doi-asserted-by":"crossref","unstructured":"Nabi S , Kahlon P , Goggins M , et al . Vzv encephalitis following successful treatment of CMV infection in a patient with kidney transplant. BMJ Case Rep 2014;2014. doi:doi:10.1136\/bcr-2014-206655. [Epub ahead of print: 02 Dec 2014].","DOI":"10.1136\/bcr-2014-206655"},{"key":"2025082711432930000_13.6.e232928.37","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiu137"},{"key":"2025082711432930000_13.6.e232928.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.jns.2014.05.035"},{"key":"2025082711432930000_13.6.e232928.39","doi-asserted-by":"crossref","first-page":"1698","DOI":"10.1016\/S0140-6736(14)60755-8","article-title":"Disseminated varicella zoster virus encephalitis","volume":"384","author":"Chai","year":"2014","journal-title":"The Lancet"},{"key":"2025082711432930000_13.6.e232928.40","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1212\/WNL.0000000000001109","article-title":"Vzv encephalitis that developed in an immunized patient during fingolimod therapy","volume":"84","author":"Issa","year":"2015","journal-title":"Neurology"},{"key":"2025082711432930000_13.6.e232928.41","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.jcv.2016.04.022","article-title":"Concomitant blindness and deafness, after varicella zoster virus encephalitis in HIV positive patient","volume":"80","author":"Afsrikordehmahin","year":"2016","journal-title":"J Clin Virol"},{"key":"2025082711432930000_13.6.e232928.42","first-page":"e61","article-title":"Clinical Reasoning: a 57-year-old woman with ataxia and oscillopsia: varicella-zoster encephalitis","volume":"87","author":"Bradshaw","year":"2016","journal-title":"Neurology"},{"key":"2025082711432930000_13.6.e232928.43","first-page":"575","volume":"17(6","author":"Bennett","year":"2017","journal-title":"C lin Med"},{"key":"2025082711432930000_13.6.e232928.44","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.12659\/AJCR.910521","article-title":"A fatal case of atypical disseminated herpes zoster in a patient with meningoencephalitis and seizures associated with steroid immunosuppression","volume":"19","author":"Fujisato","year":"2018","journal-title":"Am J Case Rep"},{"key":"2025082711432930000_13.6.e232928.45","first-page":"253","article-title":"An Autopsy Case of Meningoencephalitis and Cerebral Infarction that Developed with Ramsay Hunt Syndrome and Disseminated Herpes Zoster","volume":"70","author":"Yamashiro","year":"2018","journal-title":"Brain Nerve"},{"key":"2025082711432930000_13.6.e232928.46","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1093\/cid\/ciy984","article-title":"Characterization of virus-specific immune response during varicella zoster virus encephalitis in a young adult","volume":"69","author":"Sullivan","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2025082711432930000_13.6.e232928.47","doi-asserted-by":"crossref","first-page":"2256","DOI":"10.1177\/0300060519833529","article-title":"A case of varicella zoster encephalitis with glossopharyngeal and vagus nerve injury as primary manifestation combined with medulla lesion","volume":"47","author":"Cao","year":"2019","journal-title":"J Int Med Res"},{"key":"2025082711432930000_13.6.e232928.48","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1097\/OPX.0000000000001370","article-title":"Case report: varicella-zoster encephalitis with acute retinal necrosis and oculomotor nerve palsy","volume":"96","author":"Quan","year":"2019","journal-title":"Optom Vis Sci"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2019-232928","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T18:43:44Z","timestamp":1756320224000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2019-232928"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":48,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6,24]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1136\/bcr-2019-232928"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2019-232928","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}