2025 American Academy of Neurology Abstract Website

Objective:

To increase knowledge about VZV meningitis in pregnancy.

Background:

Varicella zoster virus (VZV) meningitis is a rare neurologic complication in immunocompetent hosts occurring in only 5-6% cases of VZV reactivation. This is an even more rare presentation during pregnancy with only two other reported cases identified. In both reported cases, patients were treated with IV acyclovir and there were no identified neonatal complications at time of delivery.

Design/Methods:

N/A

Results:

A G4P3003 34 year old at 22 weeks 1 day presented to the Obstetrics triage for a positional headache worse when leaning forward, neck pain, fever, and photophobia that had been preceded by two weeks of general malaise with a few days of subjective fever and vesicles on her buttocks and genital regions. Physical exam revealed blurring of the optic discs bilaterally on fundoscopy, positive Kernig sign, and hyperreflexia(¾) in the lower extremities was present. Lumbar puncture revealed positive varicella zoster virus (VZV) on meningitis-encephalitis panel, low glucose (44), and positive VZV IgG (200, normal 0-165). Additionally, culture from the groin lesion was positive for VZV on PCR. Treated with IV acyclovir for 2 weeks with resolution of symptoms resolved and only a mild retro-orbital bilateral headache remaining. At her maternal fetal medicine follow up five weeks later she was doing well and reported fatigue as her only symptom. Her lesions had healed. At her last fetal ultrasound, the fetus was growing appropriately. She has an upcoming follow up with Neurology.

Conclusions:

This is the third reported case presentation of VZV reactivation during pregnancy, contributing to the fund of knowledge of presentation, treatment and clinical course for both patient and fetus of this rare neurologic complication. We hope to follow up on her delivery and outcomes for the baby.