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

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 thoracicdistribution radicular pain, with amplifiable varicella zoster virus (VZV) DNA found in CSF of the first 2 patients 1 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. Control and Prevention.