Disclosures: Mona Amin: No financial relationships or conflicts of interest

Case Diagnosis: Eighty three year old male with Varicella encephalitis induced neurological dysfunction

Case Description: The patient initially presented to an urgent care with headache/fevers and was prescribed Doxycycline. He returned to the emergency department ten days later with loss of balance, unsteady gait, ataxia, persistent headache, and upper extremity tremors. The workup included chest x-ray, MRI/A, lumbar puncture (LP), C-reactive protein, urinalysis, lyme antibody, HIV, thyroid function tests, vitamin B12, and an extensive infectious workup. LP showed elevated protein and white blood cells consistent with viral encephalitis; cerebrospinal fluid was PCR Varicella positive. MRI spine detected right T1 and T6 enhancing lesions with leptomeningeal enhancement. He completed 14 days of IV Acyclovir. Prior to presentation, the patient was fully independent and ambulated several miles a day. This patient presented to an ARU with full strength in all 4 extremities, spasticity, truncal weakness, unsteady ataxic gait, diffuse hyperreflexia, and tremors limiting his ability to ambulate and perform activities of daily living independently.

Setting: Acute Rehabilitation Unit (ARU)

Assessment/Results: During the ARU stay, the patient’s functional status fluctuated as a result of medical complications including a urinary tract infection and a right lacunar stroke. Care Tool Scores- Admission: Self-care (18), Mobility (40); Discharge: Self-care (29), Mobility (46).

Discussion: Varicella encephalitis is the reactivation of a latent virus potentially leading to varying neurologic presentations. These symptoms may or may not be preceded by a blistering rash in a dermatomal distribution. It is diagnosed via LP and treated with intravenous Acyclovir. Varying presentations of varicella encephalitis including fluctuation in mental status or motor/sensory deficits make it difficult to be recognized upon initial presentation.

Conclusion: Varicella encephalitis can cause a variety of neurological dysfunctions that may mimic other more common pathologies. There is a potential role for inpatient acute rehabilitation in patients with Varicella encephalitis induced neurological dysfunction.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/varicella-encephalitis-and-neurologic-complications-in-the-acute-rehabilitation-setting/