A 6-year-old male and a 10-year-old female developed neuropsychiatric syndrome 3 to 6 weeks following a confirmed varicella-zoster virus infection with intrathecal oligoclonal bands.
The 6-year-old male presented with myasthenic syndrome, regression in school, and behavioral deterioration. In addition, he complained of seeing ‘monsters’ and was scared that he might die. He could no longer go to school and his handwriting deteriorated markedly. He had developed separation anxiety. His response to intravenous immunoglobulin (2 g/kg delivered over two days) and risperidone (0.25 mg once daily) was very poor, however, had a noticeable response to steroid therapy and a majority of the symptoms were resolved like a return to the school and handwriting was improved.
The 10-year-old female presented with marked agitation, insomnia evolving with anguish, behavioral regression, thought disturbances, and bradykinesia. She has a history of mild intellectual disability, and fine motor skills difficulties. Neuroleptics and sedative trials resulted in a mild unsustained reduction in psychomotor agitation and intravenous immunoglobulin was also unsuccessful. However, the patient was very responsive to steroid treatment.
Results
- b) Steroids
- b) Steroids
Both cases indicated a strong response and symptom resolution with steroids. Steroid responsiveness with positive cerebrospinal fluid band testing shows that the underlying mechanism of the neuropsychiatric syndrome seen is due to the cross-reactivity of anti-varicella zoster virus antibodies and the brain.
