Varicella zoster virus cerebellitis without skin manifestations in an immunocompetent adult

Oby Otu Enwo, Dina Ibrahim, Matthew Boughton, Ian Coyle-Gilchrist

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The varicella zoster virus (VZV) is a ubiquitous, neurotropic pathogen capable of reactivation from sensory ganglion cells to cause dermatomal herpes zoster infection, alongside a range of pathologies within the central nervous system. The presence of VZV cerebellitis without skin manifestations, however, is exceedingly rare in immunocompetent adults.

We report a case of VZV cerebellitis in an immunocompetent woman in her 70s, in the absence of a rash. The patient presented with a 2-week history of progressive gait ataxia, headache and mild confusion. Serological tests and neuroimaging were unremarkable. Diagnosis was confirmed through cerebrospinal fluid (CSF) analysis which revealed lymphocytosis and the presence of VZV DNA on PCR analysis. The patient showed symptomatic improvement following empirical acyclovir treatment, corroborated by favourable CSF analysis 10 days post-treatment initiation.

Infective aetiology, including VZV, should be considered in patients presenting with acute cerebellar ataxia, even in immunocompetent adults with an absence of dermatological signs.
Original languageEnglish
Article numbere252636
JournalBMJ Case Reports
Issue number1
Publication statusPublished - 30 Jan 2023


  • brain stem / cerebellum
  • headache (including migraines)
  • infection (neurology)

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