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2018

ANUÁRIO DO HOSPITAL DONA ESTEFÂNIA
REPOSITÓRIO MÉDICO CIENTÍFICO

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CEREBRAL VASCULOPATHY AFTER VARICELLA-ZOSTER INFECTION

Madalena Borges1, Jose Pedro Vieira2, Maria João Brito1

1- Unidade de Infeciologia, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa
2- Unidade de Neuropediatria, Área da Mulher, Criança e Adolescente, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisboa

-10th World Congress of The World Society for Pediatric Infectious Diseases - WSPID 2017, E-Poster

Resumo:
Introduction: Varicella is a common and benign infectious disease however complications may occur. Vascular complications such as thrombosis and vasculitis are rare but potentially serious.
Case Report: A 5-year-old boy presented with recurrent transitory (less than 12 hours) neurologic deficits – drooping of the right corner of the mouth, weakness of the right limbs and loss of the right hand’s fine motor skills, six weeks after VZV infection. The child had clear consciousness and no language deficits. Magnetic resonance imaging of the brain showed discrete irregularities in the M1 segment of the left middle cerebral artery suggestive of vasculitis without any parenchymal brain lesion. Transcranial doppler ultrasonography revealed stenosis (< 50%) of the same artery. In the EEG there was a focal, periodic and bitemporal slowing of the background activity, with left predominance. VZV-DNA was detected by polymerase chain reaction in the cerebrospinal fluid. The patient was given therapy with intravenous acyclovir (1500 mg/m2/day) and metilprednisolone (30 mg/Kg/day), followed by oral prednisolone (1 mg/Kg/day, tapering down slowly), and oral acetylisalicylic acid (5 mg/Kg/day), with clinical improvement. Reevaluation 3 and 6 months after discharge did not reveal any neurologic deficits.
Conclusion: VZV can invade the media layer of the cerebral arteries and trigger an inflammatory response, leading to vasculitis. Although it is a rare complication of varicella, this vasculopathy is a major cause of pediatric stroke. Clinical presentation as recurrent TIAs was reported previously and may warrant consideration of acute anticoagulation. This diagnosis must be considered when approaching a patient with acute neurologic deficits and a previous history of VZV infection.

Palavras Chave: cerebral vasculopathy, varicella-zosterinfection