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Diagnosis was delayed due to the atypical presentation of painless occipital zoster mimicking atopic dermatitis, and the presence of hypoglycorrhachia in his cerebrospinal fluid. The clinical diagnosis of VZV meningitis poses significant diagnostic challenges, and nucleic acid tests for VZV detection are recommended for patients with severe cases who require empiric acyclovir treatment.<\/jats:p>","DOI":"10.1136\/bcr-2023-258230","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T12:10:33Z","timestamp":1737979833000},"page":"e258230","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Varicella-zoster virus meningitis with hypoglycorrhachia, presenting with painless occipital herpes zoster mimicking atopic dermatitis"],"prefix":"10.1136","volume":"18","author":[{"given":"Aya","family":"Inamoto","sequence":"first","affiliation":[{"name":"Hiroshima Prefectural Hospital, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6392-3767","authenticated-orcid":false,"given":"Tomohiro","family":"Taniguchi","sequence":"additional","affiliation":[{"name":"General Internal Medicine & Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasumitsu","family":"Fujii","sequence":"additional","affiliation":[{"name":"General Internal Medicine & Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonoko","family":"Miyoshi","sequence":"additional","affiliation":[{"name":"General Internal Medicine & Infectious Diseases, Hiroshima Prefectural Hospital, Hiroshima, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,27]]},"reference":[{"key":"2025082707242307000_18.1.e258230.1","doi-asserted-by":"crossref","unstructured":"Khaliq MF , Kochar T , John M . 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