What is herpes zoster myelitis and how does it present?

Updated: Feb 11, 2021
  • Author: Camila K Janniger, MD; Chief Editor: Dirk M Elston, MD  more...
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That VZV can produce encephalomyelitis is well documented. More rarely, the myelitis lesion predominates or is the sole feature. The clinical picture is one of acute onset of paraplegia resulting from a diffuse involvement of the spinal cord. The picture is that associated with acute transverse myelopathy.

Spinal cord involvement becomes apparent within 2-3 weeks of the initial rash, with myelopathic findings (usually bilateral) on examination. The disease may progress for 3 weeks, though a few cases of progression for as long as 6 months have been reported in patients with AIDS. Recurrent zoster myelitis is rare, though one case has been reported of a previously healthy young woman who developed recurrent myelopathy at the same spinal level. The condition resolved fully with intravenous (IV) acyclovir treatment.

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