DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20200921

Varicella meningitis in pregnancy: a clinical conundrum

Baljeet K. Gholkar, Lynda Verghese

Abstract


Authors present this experience of managing a case of Varicella meningitis in pregnancy in a patient presenting with headache in the third trimester. There was no history of dermatomal pain or rash. After intracranial hemorrhage and thrombosis were ruled out by imaging, a decision to perform a lumbar puncture was taken. The diagnosis was made following a PCR analysis on the cerebro-spinal fluid. Retrospective testing revealed immunity to varicella at booking, thus confirming reactivation of the infection. Treatment was done using intravenous acyclovir with complete recovery. It also created a clinical dilemma for the best possible monitoring plan for the fetus to rule out affection. A fetal medicine scan revealed no structural defects in the fetus. The subsequent pregnancy period was uneventful. A well grown normal baby was born at term. This case highlights the significance of considering a lumbar puncture in cases of intractable headache and also highlights the dilemma for fetal monitoring in such rare presentations.


Keywords


Fetal varicella, Headache in pregnancy, Varicella meningitis

Full Text:

PDF

References


Takayama N, Yamada H, Kaku H. Herpes zoster in immunocompetent and immunocompromised Japanese children. Pediatr Int. 2000;42:275-9.

Ellis D, Barsell A, Riahi R, Stumpf B. Varicella zoster virus encephalitis in a patient with disseminated herpes zoster: report and review of the literature. Dermatol Online J. 2014;21(3).

Kangath RV, Lindeman TE, Brust K. Herpes zoster as a cause of viral meningitis in immunocompetent patients. Case Reports. 2013;2013:bcr2012007575.

Jayakrishanan A, Vrees R, Anderson B. Varicella zoster meningitis in a pregnant woman with acquired immunodeficiency syndrome. Am J Perinatol. 2008;25(9):573-5.

Sanguankeo A, Upala S, Sornprom S, Thamcharoen N. Varicella-zoster meningitis with a late-onset of skin eruption. BMJ Case Rep. 2015;2015:bcr-2014-208056.

Royal College of Obstetricians and Gynaecologists. Chickenpox in Pregnancy. Green-top Guideline No. 13. London: RCOG; 2015:1-17.