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February 01, 2011; 76 (5) Clinical/Scientific Notes

Zoster sine herpete: Virologic verification by detection of anti-VZV IgG antibody in CSF

D.T. Blumenthal, E. Shacham-Shmueli, F. Bokstein, D.S. Schmid, R.J. Cohrs, M.A. Nagel, R. Mahalingam, D. Gilden
First published January 31, 2011, DOI: https://doi.org/10.1212/WNL.0b013e31820a0d28
D.T. Blumenthal
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E. Shacham-Shmueli
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F. Bokstein
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D.S. Schmid
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R.J. Cohrs
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R. Mahalingam
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Citation
Zoster sine herpete: Virologic verification by detection of anti-VZV IgG antibody in CSF
D.T. Blumenthal, E. Shacham-Shmueli, F. Bokstein, D.S. Schmid, R.J. Cohrs, M.A. Nagel, R. Mahalingam, D. Gilden
Neurology Feb 2011, 76 (5) 484-485; DOI: 10.1212/WNL.0b013e31820a0d28

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Classic zoster sine herpete (ZSH) is defined clinically as dermatomal distribution pain without rash. ZSH was designated as a nosologic entity based on virologic confirmation in 3 men over age 60 with chronic thoracic-distribution radicular pain, with amplifiable varicella zoster virus (VZV) DNA found in CSF of the first 2 patients1 and in blood mononuclear cells (MNCs) in the third patient.2 Herein, we describe a patient who developed radicular pain without rash in the same dermatome as his initial cervical-distribution zoster episode, but with a remarkably prolonged interval between episodes, and in whom ZSH was virologically confirmed by the detection of anti-VZV immunoglobulin G (IgG) antibody in CSF with serum/CSF ratios indicative of intrathecal antibody synthesis.

Case report.

In 2008, a 77-year-old man developed right C8-distribution zoster; he was not treated with an antiviral agent or steroids and his rash and pain resolved completely. One year later, …

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