{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T01:53:56Z","timestamp":1781574836416,"version":"3.54.5"},"reference-count":42,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T00:00:00Z","timestamp":1781481600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Background: Varicella-zoster virus (VZV) is a neurotropic alphaherpesvirus capable of causing a broad spectrum of neurologic complications beyond classic dermatomal herpes zoster. Although meningitis and encephalitis are well recognized manifestations of neuroinvasive VZV infection, associated autonomic dysfunction remains comparatively underreported, particularly in immunocompetent individuals. Case Presentation: We describe a 66-year-old immunocompetent man who developed VZV meningoencephalitis associated with sacral dermatomal herpes zoster, urinary retention, and bowel dysmotility. Initial symptoms included fever, severe headache, photophobia, and low back pain, with delayed recognition of the characteristic sacral vesicular eruption. The patient subsequently developed encephalopathy and meningeal signs requiring intensive care unit admission. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and markedly elevated protein concentration, and VZV DNA was detected by polymerase chain reaction testing. During hospitalization, the patient developed severe urinary retention and gastrointestinal dysmotility without evidence of mechanical obstruction, raising concern for concurrent autonomic nervous system involvement. Following intravenous acyclovir therapy and supportive management, the patient experienced gradual neurologic and autonomic recovery. Conclusions: This case highlights the potential for multifocal neuroinvasive VZV disease involving both central and autonomic nervous system structures in immunocompetent hosts. Clinicians should maintain awareness that urinary retention and bowel dysmotility may represent clinically significant autonomic manifestations of VZV reactivation, particularly in the setting of sacral dermatomal involvement.<\/jats:p>","DOI":"10.3390\/idr18030058","type":"journal-article","created":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T00:49:01Z","timestamp":1781570941000},"page":"58","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Concurrent Central and Autonomic Nervous System Involvement in Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case-Based Mechanistic Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7039-828X","authenticated-orcid":false,"given":"Jordan","family":"Pyatt","sequence":"first","affiliation":[{"name":"College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5779-7407","authenticated-orcid":false,"given":"Carlos A.","family":"Uma\u00f1a Mej\u00eda","sequence":"additional","affiliation":[{"name":"Facultad de Medicina, Universidad Aut\u00f3noma de Guadalajara, Guadalajara 45129, Mexico"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3272-2539","authenticated-orcid":false,"given":"Justice","family":"Cruz","sequence":"additional","affiliation":[{"name":"Victoria College, Victoria, TX 77901, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-0682-068X","authenticated-orcid":false,"given":"Fernando","family":"Baires","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias M\u00e9dicas, Universidad Nacional Aut\u00f3noma de Honduras, Tegucigalpa 11101, Honduras"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-2480-7526","authenticated-orcid":false,"given":"Helen","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Facultad de Ciencias de la Salud, Universidad Latina de Costa Rica Powered by Arizona State University, San Jose 11501, Costa Rica"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1384-905X","authenticated-orcid":false,"given":"Joanne","family":"Cordero Guerra","sequence":"additional","affiliation":[{"name":"Infectious Disease and Pulmonary Consultants, Victoria, TX 77901, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9851-3976","authenticated-orcid":false,"given":"Miguel","family":"Sierra-Hoffman","sequence":"additional","affiliation":[{"name":"Texas A&M Rural Medicine, El Campo Memorial Hospital, Victoria, TX 77437, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8398-2518","authenticated-orcid":false,"given":"Heike","family":"Hesse","sequence":"additional","affiliation":[{"name":"Instituto de Investigaciones One Health, Universidad Tecnol\u00f3gica Centroamericana, Tegucigalpa 11101, Honduras"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6629-0007","authenticated-orcid":false,"given":"Amy C.","family":"Madril","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine, El Campo Memorial Hospital, El Campo, TX 77437, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"ref_1","first-page":"189","article-title":"Varicella-zoster virus T cell tropism and the pathogenesis of skin infection","volume":"Volume 342","author":"Arvin","year":"2010","journal-title":"Current Topics in Microbiology and Immunology"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"478","DOI":"10.1038\/306478a0","article-title":"Varicella-zoster virus DNA in human sensory ganglia","volume":"306","author":"Gilden","year":"1983","journal-title":"Nature"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"489","DOI":"10.3949\/ccjm.74.7.489","article-title":"The protean neurologic manifestations of varicella-zoster virus infection","volume":"74","author":"Nagel","year":"2007","journal-title":"Cleve Clin. 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