New-Onset Human Immunodeficiency Virus Presenting as Varicella Zoster Reactivation With Central and Peripheral Nervous System Manifestations: Report of Two Cases

Human immunodeficiency virus (HIV) affects approximately 1.2 million individuals in the United States, with immunosuppression from impaired T-cell-mediate immunity predisposing patients to a range of opportunistic infections. While varicella-zoster virus (VZV) is a known opportunistic pathogen in this population, its presentation as isolated neurological syndromes in newly diagnosed HIV patients remains uncommon and underrecognized. This case series highlights two rare and diagnostically challenging presentations of VZV-related neurological complications that led to the diagnosis of HIV. The first case involves a 30-year-old male presenting with progressive lower extremity weakness, constipation, and urinary incontinence over 10 days. Clinical, radiographic, and serological findings were consistent with VZV meningomyelitis. The second case features a 46-year-old male with acute onset back pain and unilateral leg weakness in the setting of active VZV vesicular lesions. Radiographic findings were consistent with VZV radiculitis. These cases underscore the importance of considering HIV testing in patients with atypical or severe presentations of VZV neurological involvement. This report emphasizes the diagnostic and clinical significance of recognizing such manifestations, which may serve as sentinel events for underlying immunodeficiency.