Detailed contribution information
| Contribution title | Identification of Varicella Zoster Virus Meningoencephalitis During Psychiatric Follow-up: A Multidisciplinary Approach in a Child |
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| Contribution code | D3.032 |
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| Form of presentation | Poster |
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| Abstract |
Varicella zoster virus (VZV) primarily causes chickenpox, becomes latent in the ganglia, and can present with neurological symptoms upon reactivation. In this report, we discuss a case of VZV meningoencephalitis in a boy with hydrocephalus, a shunt, intellectual disability, and ongoing psychiatric medication. The clinical presentation initially associated with psychiatric diagnosis and treatment, was later determined to be related to an underlying organic pathology. A ten-year-old boy with a history of hydrocephalus, ventriculoperitoneal shunt, and mild cognitive impairment, was brought to our clinic by his mother due to complaints of anxiety. His symptoms had started a year earlier following a bicycle accident and had worsened after his uncle's sudden hospitalization. The patient exhibited excessive distress when separated from his mother and expressed concern about harm coming to his parents. He was diagnosed with separation anxiety disorder according to DSM-V and gradually started on sertraline 50 mg/day. During follow-ups, sertraline treatment resulted in a reduction in anxiety severity. Additionally, due to symptoms of inattention, difficulty sustaining attention, and hyperactivity, he was diagnosed with attention deficit hyperactivity disorder, and atomoxetine 25 mg/day was added to the treatment. On the fifth day of treatment, the patient developed headache and drowsiness. The medication was discontinued, but symptoms persisted. Initial neurological assessments were unremarkable. However, the patient presented to the emergency department with increased sedation, behavioral changes, and pain at the shunt site. He was diagnosed with VZV meningoencephalitis secondary to shunt infection and hospitalized for acyclovir and ceftriaxone therapy. He had not been vaccinated as he had contracted chickenpox during infancy. The psychiatric evaluation after discharge revealed significant improvement in behavioral symptoms. This case emphasizes the importance of a multidisciplinary approach when evaluating patients with comorbidities. Although there was initially thought to be a temporal relationship between the onset of symptoms and the addition of medication, a comprehensive evaluation revealed the presence of an underlying organic pathology. Especially when symptoms present acutely, it is crucial to perform a thorough evaluation for potential underlying organic causes. Informed consent was obtained from the patient's parents. |