Herpes Zoster Myelitis

Left thoracic herpes zoster in a 59-year-old woman was succeeded by myelopathy ascending in a saltatory manner over ten weeks until death occurred by pulmonary embolus. Dexamethasone therapy was instituted ten days after the rash began. Pathologic findings were those of a unicentric and progressive gangliomyelopathy with cicatrization of the left T-8 dorsal root ganglion and complete necrosis of the spinal cord from T-8 to T-11 with serpentine extension caudally to L-5 and rostrally to C3. Cowdry type A intranuclear inclusion bodies and structures in glial cells consistent with nucleocapsids ofHerpesviruswere observed in cervical spinal cord.Herpesvirus varicella(VZ virus) was isolated and identified in the cervical spinal cord. The findings suggest that herpes zoster myelitis is mediated by direct viral invasion and cell lysis.