Varicella Zoster Meningitis with Hypoglycorrhachia on Cerebrospinal Fluid (CSF) Analysis in a Young Immunocompetent Host without a Rash

Patient: Female, 44 Final Diagnosis: Varicella zoster meningitis Symptoms: Headache Medication: — Clinical Procedure: — Specialty: Infectious Diseases OBJECTIVE: Unusual clinical course BACKGROUND: Varicella zoster virus (VZV) is a common viral infection, with primary infection presenting as fevers and pruritic vesicular rash. After staying dormant in the dorsal root ganglia, reactivation can lead to secondary infection. Meningitis is a rare a complication of VZV infection. CASE REPORT: We report a case of a 44-year-old woman with no past medical history, presenting with severe frontal headache without meningeal signs or fevers, found to have VZV meningitis. CSF analysis revealed hypoglycorrhachia and she was treated successfully with combination of intravenous acyclovir and oral valacyclovir. CONCLUSIONS: VZV meningitis can present with subtle clinical signs and symptoms and should be considered as a possible etiology for headaches without identifiable cause.