Disclosures: Jose O. Malave, MD: Nothing to disclose

Case Description: A 29-year-old woman (G1P1) with a history of systemic lupus erythematosus, chronic renal failure, and thrombotic thrombocytopenic purpura developed flulike symptoms and a pruritic chest rash soon after starting oral steroids prescribed by her rheumatologist. The rash was noted to be maculopapular, in a dermatomal distribution, and included the right eye. Based on the appearance of the rash and history of chronic steroid use, there was initial concern for disseminated varicella-zoster virus (VZV). Lumbar puncture with PCR confirmed VZV in the CSF. She developed tracheal involvement with subsequent hypoxic respiratory failure requiring intubation; acutely worsening generalized weakness led to a diagnosis of VZV meningitis vs. neuritis. Continuing inability to protect her airway lead to tracheostomy placement. She developed marked bilateral lower extremity weakness, and CT head revealed hypodensity in the bilateral frontal lobes, concerning for ischemia versus VZV encephalitis; a subsequent lumbar MRI revealed abnormal enhancement of descending lumbar nerve roots, likely secondary to VZV meningitis vs neuritis. Her mental status worsened, and brain MRI revealed 20 areas of scattered hyperintensity concerning for encephalitis. She was treated with acyclovir, followed by valacyclovir, a PEG tube was placed, and she was transferred for inpatient rehabilitation.

Setting: Academic rehabilitation hospital.

Patient: A 29-year-old woman with a history of SLE, CKD3, and TTP.

Assessment/Results: She improved with continued treatment of VZV, but her resulting paraplegia has yet to fully resolve. Her rehabilitation course was complicated by aspiration pneumonia secondary to poor GI motility and intolerance of tube feeds.

Discussion: Localized VZV rapidly progressed to disseminated disease in an immunocompromised host, leading to paraplegia and encephalitis.

Conclusion: Patients on oral steroids should be closely monitored for development of opportunistic infections and promptly treated.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/disseminated-zoster-resulting-in-paraplegia-a-case-report/