{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T06:12:13Z","timestamp":1792131133235,"version":"4.4.0"},"reference-count":12,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,6,3]]},"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:p>A 52-year-old woman with HIV and recent antiretroviral therapy non-adherence presented with a 5-day history of widespread painful vesicular skin lesions. Direct fluorescent antibody testing of the skin lesions was positive for varicella zoster virus (VZV). On day 3, she developed profound right upper extremity weakness. MRI of the brain and cervical spine was suggestive of VZV myelitis. Lumbar puncture was positive for VZV PCR in the cerebrospinal fluid (CSF) and CSF HIV viral load was detected at 1030 copies\/mL, indicating \u2018secondary\u2019 HIV CSF escape. She was treated with intravenous acyclovir for 4 weeks and subsequent oral therapy with famciclovir then valacyclovir for 6 weeks. She also received dexamethasone. The patient had an almost full recovery at 6 months. Myelitis is a rare complication of reactivated VZV infection that can have atypical presentation in immunocompromised patients. Such \u2018secondary\u2019 HIV CSF escape should be considered in immunosuppressed patients with concomitant central nervous system infection.<\/jats:p>","DOI":"10.1136\/bcr-2021-241738","type":"journal-article","created":{"date-parts":[[2021,6,29]],"date-time":"2021-06-29T12:55:25Z","timestamp":1624971325000},"page":"e241738","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["VZV myelitis with secondary HIV CSF escape"],"prefix":"10.1136","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4050-6690","authenticated-orcid":false,"given":"Julian J","family":"Weiss","sequence":"first","affiliation":[{"name":"Neurology, Yale University School of Medicine, New Haven, Connecticut, USA"},{"name":"Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Serena","family":"Spudich","sequence":"additional","affiliation":[{"name":"Neurology, Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lydia","family":"Barakat","sequence":"additional","affiliation":[{"name":"Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,6,29]]},"reference":[{"key":"2025082804024220000_14.6.e241738.1","doi-asserted-by":"publisher","DOI":"10.1080\/00365540050165893"},{"key":"2025082804024220000_14.6.e241738.2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/21.2.370"},{"key":"2025082804024220000_14.6.e241738.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200003023420906"},{"key":"2025082804024220000_14.6.e241738.4","doi-asserted-by":"crossref","first-page":"1818","DOI":"10.1212\/WNL.44.10.1818","article-title":"Varicella-Zoster virus myelitis: an expanding spectrum","volume":"44","author":"Gilden","year":"1994","journal-title":"Neurology"},{"key":"2025082804024220000_14.6.e241738.5","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-015-0267-7"},{"key":"2025082804024220000_14.6.e241738.6","doi-asserted-by":"publisher","DOI":"10.2214\/ajr.161.1.8390790"},{"key":"2025082804024220000_14.6.e241738.7","doi-asserted-by":"crossref","first-page":"770","DOI":"10.5858\/2001-125-0770-VZVIOT","article-title":"Varicella-Zoster virus infections of the nervous system: clinical and pathologic correlates","volume":"125","author":"Kleinschmidt-DeMasters","year":"2001","journal-title":"Arch Pathol Lab Med"},{"key":"2025082804024220000_14.6.e241738.8","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.47.4.929"},{"key":"2025082804024220000_14.6.e241738.9","doi-asserted-by":"publisher","DOI":"10.1007\/s13311-016-0430-x"},{"key":"2025082804024220000_14.6.e241738.10","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix035"},{"key":"2025082804024220000_14.6.e241738.11","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit356"},{"key":"2025082804024220000_14.6.e241738.12","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0236162","article-title":"Herpes zoster in HIV-1 infection: the role of CSF pleocytosis in secondary CSF escape and discordance","volume":"15","author":"Hagberg","year":"2020","journal-title":"PLoS One"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-241738","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T11:02:48Z","timestamp":1756378968000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-241738"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6]]},"references-count":12,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,6,29]]},"published-print":{"date-parts":[[2021,6]]}},"alternative-id":["10.1136\/bcr-2021-241738"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-241738","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6]]}}}