Herpes zoster and multiple sclerosis: case study and short review

Abstract

A 37 year old man developed typical varicella zoster virus (VZV) infection affecting the left clavicular area (C4 dermatome). Subsequently, he experienced numbness over the left scapula, arm, and palm. This improved gradually over one and half months. Two months later, he had numbness affecting the right thigh. MRI showed ovoid lesions in the corpus callosum and hyperintense signal in the cervical cord area. Based on the clinical features of presence of CNS lesions that were disseminated in time and space with no better explanation for the disease process, multiple sclerosis (MS) was diagnosed. The patient was treated with oral azathioprine, gabapentin and amitryptyline and patient improved symptomatically . A brief literature review was conducted on the etiological link between VZV infection and MS, early diagnosis, and early treatment of MS. The ultrastructural finding of viral particles identical to VZV, together with the simultaneous presence of large quantities of DNA from VZV in the CSF, almost restricted to the periods of exacerbation, as well as its steady diminution and eventual disappearance from clinical relapse to clinical remission constitute the strongest evidence to date to support the participation of VZV in the pathogenesis of MS. Suppression of relapsing phases of the disease with immuno-modulatory treatment is the present day management consensus.