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An 80-year-old man with a history of renal transplant, on tacrolimus and prednisone, presented with confusion and fever (38.3°C). Brain MRI demonstrated leptomeningeal enhancement, and lumbar puncture revealed a mixed… Click to show full abstract
An 80-year-old man with a history of renal transplant, on tacrolimus and prednisone, presented with confusion and fever (38.3°C). Brain MRI demonstrated leptomeningeal enhancement, and lumbar puncture revealed a mixed pleocytosis with 533 white blood cells/μL (45% lymphocytes) and 950 red blood cells/μL. Varicella zoster was identified in the CSF by PCR. He exhibited diffuse hyperreflexia and clonus at the bilateral finger and wrist flexors within 72 hours of admission (video, links.lww.com/WNL/A323). Spasticity and clonus are pathologic upper motor neuron signs that can be observed early in the course of meningoencephalitis1 and other acute neurologic disorders.2
Journal Title: Neurology
Year Published: 2018
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