Encefalitis varicel·losa greu en un pacient immunocompetent

Introduction. Varicella is a relatively mild disease in which neurological complications are rare. Among them, the most common is ataxia, and encephalitis is the most severe. Complications of varicella are seldom observed in immunocompetent patients. Case report. A 12-yr-old immunocompetent patient presented with skin manifestations of varicella and was started on acyclovir. Eight days later he complained of headache, horizontal nystagmus and diplopia, followed by a sudden neurological derangement requiring mechanical ventilation and ICP and SjO2 monitoring. An urgent CT showed marked edema of the right brain hemisphere. After a 1 month stay in the pediatric ICU he was discharged with mild left hemiparesis. Discussion. Encephalitis is the most severe complication of varicella. It presents most commonly between the second and sixth day after the onset of the rash, but can precede it. Diagnosis is made by blood and CSF serologies or by PCR assay for VZV. Treatment includes parenteral acyclovir, adding glucocorticoids in the most severe cases. Overall mortality ranges between 10 and 20%.