{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T20:39:11Z","timestamp":1789072751141,"version":"build-2803163510"},"reference-count":19,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,1,4]]},"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>The varicella zoster virus (VZV) is a ubiquitous, neurotropic pathogen capable of reactivation from sensory ganglion cells to cause dermatomal herpes zoster infection, alongside a range of pathologies within the central nervous system. The presence of VZV cerebellitis without skin manifestations, however, is exceedingly rare in immunocompetent adults.<\/jats:p>\n               <jats:p>We report a case of VZV cerebellitis in an immunocompetent woman in her 70s, in the absence of a rash. The patient presented with a 2-week history of progressive gait ataxia, headache and mild confusion. Serological tests and neuroimaging were unremarkable. Diagnosis was confirmed through cerebrospinal fluid (CSF) analysis which revealed lymphocytosis and the presence of VZV DNA on PCR analysis. The patient showed symptomatic improvement following empirical acyclovir treatment, corroborated by favourable CSF analysis 10 days post-treatment initiation.<\/jats:p>\n               <jats:p>Infective aetiology, including VZV, should be considered in patients presenting with acute cerebellar ataxia, even in immunocompetent adults with an absence of dermatological signs.<\/jats:p>","DOI":"10.1136\/bcr-2022-252636","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T11:21:37Z","timestamp":1675077697000},"page":"e252636","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Varicella zoster virus cerebellitis without skin manifestations in an immunocompetent adult"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4287-7145","authenticated-orcid":false,"given":"Oby Otu","family":"Enwo","sequence":"first","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich, UK"},{"name":"Neurology, Norfolk and Norwich University Hospital, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Ibrahim","sequence":"additional","affiliation":[{"name":"Neurology, Norfolk and Norwich University Hospital, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Boughton","sequence":"additional","affiliation":[{"name":"Leeds Teaching Hospitals NHS Trust, Leeds, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8887-1801","authenticated-orcid":false,"given":"Ian","family":"Coyle-Gilchrist","sequence":"additional","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich, UK"},{"name":"Neurology, Norfolk and Norwich University Hospital, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,1,30]]},"reference":[{"key":"2025082801501776000_16.1.e252636.1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.60.6.877"},{"key":"2025082801501776000_16.1.e252636.2","article-title":"A rare cause of childhood cerebellitis-influenza infection: a case report and systematic review of literature","volume":"2017","author":"G\u00f6k\u00e7e","year":"2017","journal-title":"Case Rep Pediatr"},{"key":"2025082801501776000_16.1.e252636.3","doi-asserted-by":"publisher","DOI":"10.1007\/s12311&ndash;015&ndash;0687&ndash;3."},{"key":"2025082801501776000_16.1.e252636.4","doi-asserted-by":"publisher","DOI":"10.1055\/s-0032-1324732"},{"key":"2025082801501776000_16.1.e252636.5","doi-asserted-by":"publisher","DOI":"10.1159\/000050381"},{"key":"2025082801501776000_16.1.e252636.6","doi-asserted-by":"crossref","DOI":"10.1007\/s11910-013-0374-z","article-title":"The variegate neurological manifestations of varicella zoster virus infection","volume":"13","author":"Gilden","year":"2013","journal-title":"Curr Neurol Neurosci Rep"},{"key":"2025082801501776000_16.1.e252636.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ncl.2014.07.009"},{"key":"2025082801501776000_16.1.e252636.8","doi-asserted-by":"crossref","first-page":"984","DOI":"10.1016\/S1474-4422(06)70601-9","article-title":"Acute cerebellar ataxia in a 41 year old woman","volume":"5","author":"Moses","year":"2006","journal-title":"Lancet Neurol"},{"key":"2025082801501776000_16.1.e252636.9","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/S0140-6736(06)67967-1","article-title":"Varicella zoster virus cerebellitis in a 66-year-old patient without herpes zoster","volume":"367","author":"Ratzka","year":"2006","journal-title":"Lancet"},{"key":"2025082801501776000_16.1.e252636.10","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1111\/j.1447-0594.2012.00857.x","article-title":"Case of acute cerebellitis as a result of varicella zoster virus infection without skin manifestations","volume":"12","author":"Suzuki","year":"2012","journal-title":"Geriatr Gerontol Int"},{"key":"2025082801501776000_16.1.e252636.11","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1097\/NRL.0000000000000051","article-title":"Varicella zoster virus cerebellitis without a rash in an immunocompetent 85-year-old patient","volume":"20","author":"Shilo","year":"2015","journal-title":"Neurologist"},{"key":"2025082801501776000_16.1.e252636.12","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.ensci.2018.04.003","article-title":"A case of cerebellar ataxia associated with VZV infection","volume":"11","author":"Matsuyama","year":"2018","journal-title":"ENeurologicalSci"},{"key":"2025082801501776000_16.1.e252636.13","doi-asserted-by":"crossref","unstructured":"Cross C , English S , Krause M , et al . A 59 year-old immunocompetent man with rapid onset of truncal ataxia: A case of acute cerebellitis secondary to varicella zoster virus. Neurology 2019;92.","DOI":"10.1212\/WNL.92.15_supplement.P4.9-035"},{"key":"2025082801501776000_16.1.e252636.14","doi-asserted-by":"publisher","DOI":"10.1007\/s11910-009-0064-z"},{"key":"2025082801501776000_16.1.e252636.15","doi-asserted-by":"crossref","DOI":"10.1186\/s13104-017-2935-8","article-title":"Acute cerebellitis in adults: a case report and review of the literature","volume":"10","author":"Van Samkar","year":"2017","journal-title":"BMC Res Notes"},{"key":"2025082801501776000_16.1.e252636.16","doi-asserted-by":"crossref","first-page":"15016","DOI":"10.1038\/nrdp.2015.16","article-title":"Varicella zoster virus infection","volume":"1","author":"Gershon","year":"2015","journal-title":"Nat Rev Dis Primers"},{"key":"2025082801501776000_16.1.e252636.17","doi-asserted-by":"crossref","DOI":"10.3389\/fmicb.2018.03170","article-title":"Varicella virus-host interactions during latency and reactivation: lessons from simian varicella virus","volume":"9","author":"Sorel","year":"2018","journal-title":"Front Microbiol"},{"key":"2025082801501776000_16.1.e252636.18","doi-asserted-by":"publisher","DOI":"10.1517\/14656566.5.3.551"},{"key":"2025082801501776000_16.1.e252636.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.neulet.2018.07.005"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2022-252636","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T08:50:23Z","timestamp":1756371023000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2022-252636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1]]},"references-count":19,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1,30]]},"published-print":{"date-parts":[[2023,1]]}},"alternative-id":["10.1136\/bcr-2022-252636"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2022-252636","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1]]}}}