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2026, Vol: 16, Issue: 3
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Title Page

Case Report


Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus

Shankar Lal, Shahnawaz Notta, Harsha Vedantam, Dima Youssef, Savannah Grace Moore Shankar Lal, Savannah Gracie Moore, Harsha Vedantam, Shahnawaz Notta, Beesham Kumar.


Abstract
Background:
Varicella-zoster virus (VZV) reactivation can rarely involve the central nervous system, leading to meningitis even in otherwise healthy elderly patients. Clinical presentation may be subtle, occasionally mimicking transient ischemic attacks or strokes, which can delay diagnosis.

Case Description:
We report an 85-year-old man with multiple vascular risk factors who experienced a brief episode of expressive aphasia. Neuroimaging showed no acute ischemia. Examination revealed a healing unilateral vesicular rash in the ophthalmic (V1) dermatome. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and elevated protein, and polymerase chain reaction testing confirmed VZV DNA. The patient was treated with a 14-day course of intravenous acyclovir, resulting in complete neurologic recovery.

Conclusion:
This case emphasizes the need to consider VZV meningitis in elderly patients presenting with transient neurological deficits, even without classic meningeal signs.

Key words: Acyclovir; Cerebrospinal fluid; Expressive aphasia; Varicella-zoster virus; VZV meningitis.


 
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How to Cite this Article
Pubmed Style

Lal S, Notta S, Vedantam H, Youssef D, Lal SGMS, Moore SG, Vedantam H, Notta S, Kumar B. Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus. J Microbiol Infect Dis. 2026; 16(3): 156-159. doi:10.5455/JMID.2026.v16.i3.4

Web Style

Lal S, Notta S, Vedantam H, Youssef D, Lal SGMS, Moore SG, Vedantam H, Notta S, Kumar B. Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus. https://www.jmidonline.org/?mno=312305 [Access: July 25, 2026]. doi:10.5455/JMID.2026.v16.i3.4

AMA (American Medical Association) Style

Lal S, Notta S, Vedantam H, Youssef D, Lal SGMS, Moore SG, Vedantam H, Notta S, Kumar B. Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus. J Microbiol Infect Dis. 2026; 16(3): 156-159. doi:10.5455/JMID.2026.v16.i3.4


Vancouver/ICMJE Style

Lal S, Notta S, Vedantam H, Youssef D, Lal SGMS, Moore SG, Vedantam H, Notta S, Kumar B. Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus. J Microbiol Infect Dis. (2026), [cited July 25, 2026]; 16(3): 156-159. doi:10.5455/JMID.2026.v16.i3.4


Harvard Style

Lal, S., Notta, . S., Vedantam, . H., Youssef, . D., Lal, . S. G. M. S., Moore, . S. G., Vedantam, . H., Notta, . S. & Kumar, . B. (2026) Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus. J Microbiol Infect Dis, 16 (3), 156-159. doi:10.5455/JMID.2026.v16.i3.4


Turabian Style

Lal, Shankar, Shahnawaz Notta, Harsha Vedantam, Dima Youssef, Savannah Grace Moore Shankar Lal, Savannah Gracie Moore, Harsha Vedantam, Shahnawaz Notta, and Beesham Kumar. 2026. Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus. Journal of Microbiology and Infectious Diseases, 16 (3), 156-159. doi:10.5455/JMID.2026.v16.i3.4


Chicago Style

Lal, Shankar, Shahnawaz Notta, Harsha Vedantam, Dima Youssef, Savannah Grace Moore Shankar Lal, Savannah Gracie Moore, Harsha Vedantam, Shahnawaz Notta, and Beesham Kumar. "Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus." Journal of Microbiology and Infectious Diseases 16 (2026), 156-159. doi:10.5455/JMID.2026.v16.i3.4


MLA (The Modern Language Association) Style

Lal, Shankar, Shahnawaz Notta, Harsha Vedantam, Dima Youssef, Savannah Grace Moore Shankar Lal, Savannah Gracie Moore, Harsha Vedantam, Shahnawaz Notta, and Beesham Kumar. "Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus." Journal of Microbiology and Infectious Diseases 16.3 (2026), 156-159. Print. doi:10.5455/JMID.2026.v16.i3.4


APA (American Psychological Association) Style

Lal, S., Notta, . S., Vedantam, . H., Youssef, . D., Lal, . S. G. M. S., Moore, . S. G., Vedantam, . H., Notta, . S. & Kumar, . B. (2026) Varicella-zoster virus meningitis presenting as transient expressive aphasia in an elderly patient with herpes zoster ophthalmicus. Journal of Microbiology and Infectious Diseases, 16 (3), 156-159. doi:10.5455/JMID.2026.v16.i3.4


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