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Pediatr Int. 2017 Oct;59(10):1116-1118. doi: 10.1111/ped.13362.

Herpes zoster meningitis in immunocompetent children: Two case reports and a literature review.

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Department of Pediatrics, Kitano Hospital, Tazuke Kofukai Medical Research Institute, Osaka City, Osaka, Japan.


We encountered two cases of Herpes zoster (HZ) meningitis, a rarely occurring complication of HZ, in previously healthy children. One patient treated with i.v. acyclovir (ACV, 31 mg/kg/day) did not recover. His symptoms were relieved somewhat by increased ACV dosage, but it caused transient renal dysfunction. Another patient treated with i.v. ACV (30 mg/kg/day) recovered. Treatment for HZ meningitis in immunocompetent children has not been established. In a literature review, 80% of 20 patients were treated with the usual dose of ACV 15-30 mg/kg/day. The present cases suggest that a high dosage of ACV up to 60 mg/kg/day should be considered (while monitoring for side-effects) unless symptoms improve. In the review, one of every three vaccine-strain Varicella zoster virus (VZV) cases was severe, whereas the present cases resulted from wild type. Further investigations must examine different clinical characteristics of HZ meningitis caused by wild-type and vaccine-strain VZV.


Herpes zoster; acyclovir; immunocompetent children; meningitis; varicella vaccine

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