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A Case of Multiple Cranial Nerve Palsy with Immune Reconstitution Inflammatory Syndrome Caused by Varicella Zoster Virus in a Patient with AIDS
1)Department of Laboratory Medicine, Tokyo Medical University Hospital, Japan, 2)Department of General Medicine, Chiba University Hospital, Japan
Ryoko SEKIYA1), Taijirou SHIROKAWA2), Ryui MIYASHITA1), Akito ICHIKI1), Yushi CHIKASAWA1), Masato BINGO1), Takashi MURAMATSU1), Kazuhisa YOKOTA1), Mihoko YOTSUMOTO1), Takeshi HAGIWARA1), Kagehiro AMANO1) & Katsuyuki FUKUTAKE1)
(Received March 14, 2019)
(Accepted September 24, 2019)
Key words: varicella zoster virus, multiple cerebral nerve palsy, immune reconstitution inflammatory syndrome

Varicella zoster virus (VZV) is known to cause immune reconstitution inflammatory syndrome (IRIS) in a high frequency in people infected with human immunodeficiency virus (HIV). However, severe cases of IRIS resulting in multiple cerebral nerve palsy are rare. We herein report on a case of an HIV-infected man who developed IRIS caused by VZV, presenting as multiple cranial nerve palsy involving cranial nerves V, VII, VIII, IX, X, and XII. The patient was a 40-year-old man who was diagnosed as having AIDS triggered by esophageal candidiasis 3 months previously. About 3 months after starting antiretroviral drug treatment, he was hospitalized with difficulty in swallowing, fever, and an exacerbated rash. His CD4 cell count was 42 cells/μL, and the HIV-RNA level was undetectable. The characteristic symptom of papules and scabs of different stages all over the body enabled us to quickly reach the correct diagnosis of VZV-IRIS. The patient was treated with acyclovir, corticosteroid pulses, and antiretroviral therapy. Although the patient's hypoglossal nerve palsy quickly improved, his swallowing difficulty required over 8 months to improve.

[ Kansenshogaku Zasshi 93: 775-779, 2019 ]

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