{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:11:28Z","timestamp":1782220288364,"version":"3.54.5"},"reference-count":22,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2019,5,23]],"date-time":"2019-05-23T00:00:00Z","timestamp":1558569600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Varicella-zoster virus (VZV) is a human neurotropic herpes virus that causes chickenpox in children. After becoming latent in dorsal root ganglia, it can reactivate to cause dermatological manifestations, the most common one being shingles or herpes zoster. Severe neurologic dysfunctions can occur in immunocompromised patients such as encephalitis, meningitis, myelitis and neuropathy. Longitudinal extensive transverse myelitis (LETM) is an unusual neurological complication mainly described in immunocompromised patients, with very few cases described in immunocompetent ones. We hereby report a case of VZV-induced LETM in an immunocompetent older adult\u2014a situation rarely described in the literature. LETM is a rare complication of VZV and its pathogenesis; therapeutic interventions and prognosis are far from being fully clarified. However, a prompt diagnosis is needed to allow a rapid initialization of treatment and ensure a better outcome. Although the therapeutic lines are not clear, immunosuppressive agents may have their place in cases of unsuccessful results and\/or relapses following acyclovir coupled with a well conducted methylprednisolone therapy. Further studies are highly needed to improve the current understanding of the disease course and mechanisms, and to optimize therapeutic strategies.<\/jats:p>","DOI":"10.3390\/medicina55050201","type":"journal-article","created":{"date-parts":[[2019,5,24]],"date-time":"2019-05-24T02:22:00Z","timestamp":1558664520000},"page":"201","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Longitudinal Extensive Transverse Myelitis in an Immunocompetent Older Individual\u2014A Rare Complication of Varicella-Zoster Virus Reactivation"],"prefix":"10.3390","volume":"55","author":[{"given":"Samar A.","family":"Abbas","sequence":"first","affiliation":[{"name":"Department of Neurology, H\u00f4tel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanine","family":"El Helou","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4tel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0880-8608","authenticated-orcid":false,"given":"Moussa A.","family":"Chalah","sequence":"additional","affiliation":[{"name":"EA 4391, Excitabilit\u00e9 Nerveuse et Th\u00e9rapeutique, Universit\u00e9 Paris-Est-Cr\u00e9teil, 94010 Cr\u00e9teil, France"},{"name":"Service de Physiologie\u2014Explorations Fonctionnelles, H\u00f4pital Henri Mondor, Assistance Publique\u2014H\u00f4pitaux de Paris, 94010 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanine","family":"Hilal","sequence":"additional","affiliation":[{"name":"Department of Neurology, Bellevue Medical Center University Hospital, Beirut 1104-2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaby","family":"Saliba","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, H\u00f4tel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Halim","family":"Abboud","sequence":"additional","affiliation":[{"name":"Department of Neurology, H\u00f4tel-Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut 1104-2020, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0188-1957","authenticated-orcid":false,"given":"Samar S.","family":"Ayache","sequence":"additional","affiliation":[{"name":"EA 4391, Excitabilit\u00e9 Nerveuse et Th\u00e9rapeutique, Universit\u00e9 Paris-Est-Cr\u00e9teil, 94010 Cr\u00e9teil, France"},{"name":"Service de Physiologie\u2014Explorations Fonctionnelles, H\u00f4pital Henri Mondor, Assistance Publique\u2014H\u00f4pitaux de Paris, 94010 Cr\u00e9teil, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,5,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1007\/s11910-009-0064-z","article-title":"Neurologic manifestations of varicella zoster virus infections","volume":"9","author":"Jubelt","year":"2009","journal-title":"Curr. Neurol. Neurosci. Rep."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.2169\/internalmedicine.50.5786","article-title":"Longitudinally disseminated spinal cord lesions (moth-eaten appearance) in varicella-zoster myelitis","volume":"50","author":"Tajima","year":"2011","journal-title":"Intern. Med."},{"key":"ref_3","first-page":"1","article-title":"Varicella-zoster virus longitudinally extensive myelitis in an immunocompetent patient","volume":"50","author":"Fernandes","year":"2014","journal-title":"Rev. Bras. Neurol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"334","DOI":"10.3947\/ic.2016.48.4.334","article-title":"A case of transverse myelitis caused by varicella zoster virus in an immunocompetent older patient","volume":"48","author":"Lee","year":"2016","journal-title":"Infect. Chemother."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.msard.2017.09.022","article-title":"Post herpes zoster infection neuromyelitis optica spectrum disorder","volume":"18","author":"Mathew","year":"2017","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1016\/j.jns.2008.08.015","article-title":"Aquaporin-4 antibody positive longitudinally extensive transverse myelitis following varicella zoster infection","volume":"276","author":"Heerlein","year":"2009","journal-title":"J. Neurol. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"26","DOI":"10.5692\/clinicalneurol.cn-000820","article-title":"A case of anti aquapolin-4 antibody positive myelitis with hyperhidrosis, following herpes zoster","volume":"57","author":"Suda","year":"2017","journal-title":"Rinsho Shinkeigaku"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.jns.2013.07.2510","article-title":"A recurrent longitudinally extensive transverse myelitis with Aquaporin-4 (AQP4) antibody after herpes zoster","volume":"334","author":"Park","year":"2013","journal-title":"J. Neurol. Sci."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1056\/NEJM200003023420906","article-title":"Neurologic complications of the reactivation of Varicella-Zoster virus","volume":"342","author":"Gilden","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jns.2012.04.017","article-title":"Features of varicella zoster virus myelitis and dependence on immune status","volume":"318","author":"Hung","year":"2012","journal-title":"J. Neurol. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.jneuroim.2018.05.005","article-title":"Long-term outcomes of varicella zoster virus infection-related myelitis in 10 immunocompetent patients","volume":"321","author":"Wang","year":"2018","journal-title":"J. Neuroimmunol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"241","DOI":"10.7326\/0003-4819-76-2-241","article-title":"Varicella zoster infection in patients with cancer","volume":"76","author":"Schimpff","year":"1972","journal-title":"Ann. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1181","DOI":"10.1093\/brain\/114.3.1181","article-title":"Herpes zoster myelitis","volume":"114","author":"Devinsky","year":"1991","journal-title":"Brain"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"958","DOI":"10.1172\/JCI64096","article-title":"Causes, consequences, and reversal of immune system aging","volume":"123","author":"Dorshkind","year":"2013","journal-title":"J. Clin. Investig."},{"key":"ref_15","first-page":"89A","article-title":"Varicella zoster virus and central nervous system syndromes","volume":"11","author":"Gilden","year":"2004","journal-title":"Herpes"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1097\/NRL.0000000000000016","article-title":"Acute longitudinal and hemorrhagic myelitis caused by varicella-zoster virus in an immunocompetent adolescent","volume":"19","author":"Wang","year":"2015","journal-title":"Neurologist"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1001\/archneur.1973.00490290049004","article-title":"Herpes zoster myelitis: Evidence for viral invasion of spinal cord","volume":"29","author":"Hogan","year":"1973","journal-title":"Arch. Neurol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"103","DOI":"10.2217\/14796708.4.1.103","article-title":"Clinical and molecular aspects of varicella zoster virus infection","volume":"4","author":"Gilden","year":"2009","journal-title":"Future Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1097\/00019052-200206000-00019","article-title":"Immunopathogenesis of acute transverse myelitis","volume":"15","author":"Kerr","year":"2002","journal-title":"Curr. Opin. Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/S0035-3787(07)90359-8","article-title":"VZV-related myelitis: a pathophysiological hypothesis","volume":"163","author":"Outteryck","year":"2007","journal-title":"Rev. Neurol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1007\/s11940-013-0246-5","article-title":"Complications of varicella zoster virus reactivation","volume":"15","author":"Nagel","year":"2013","journal-title":"Curr. Treat. Options Neurol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.1086\/342963","article-title":"Varicella-zoster virus: atypical presentations and unusual complications","volume":"186","author":"Gnann","year":"2002","journal-title":"J. Infect. 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