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Infectious Disease Reports
Volume 18
Issue 3
10.3390/idr18030058
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Case Report

Concurrent Central and Autonomic Nervous System Involvement in Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case-Based Mechanistic Analysis

by
Jordan Pyatt
1,
Carlos A. Umaña Mejía
2,
Justice Cruz
3,
Fernando Baires
4,
Helen Hoffman
5,
Joanne Cordero Guerra
6,
Miguel Sierra-Hoffman
7,
Heike Hesse
8 and
Amy C. Madril
9,*
1
College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA
2
Facultad de Medicina, Universidad Autónoma de Guadalajara, Guadalajara 45129, Mexico
3
Victoria College, Victoria, TX 77901, USA
4
Facultad de Ciencias Médicas, Universidad Nacional Autónoma de Honduras, Tegucigalpa 11101, Honduras
5
Facultad de Ciencias de la Salud, Universidad Latina de Costa Rica Powered by Arizona State University, San Jose 11501, Costa Rica
6
Infectious Disease and Pulmonary Consultants, Victoria, TX 77901, USA
7
Texas A&M Rural Medicine, El Campo Memorial Hospital, Victoria, TX 77437, USA
8
Instituto de Investigaciones One Health, Universidad Tecnológica Centroamericana, Tegucigalpa 11101, Honduras
9
Department of Hospital Medicine, El Campo Memorial Hospital, El Campo, TX 77437, USA
*
Author to whom correspondence should be addressed.
Infect. Dis. Rep. 2026, 18(3), 58; https://doi.org/10.3390/idr18030058
Submission received: 7 April 2026 / Revised: 4 June 2026 / Accepted: 9 June 2026 / Published: 15 June 2026
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Abstract

Background: Varicella-zoster virus (VZV) is a neurotropic alphaherpesvirus capable of causing a broad spectrum of neurologic complications beyond classic dermatomal herpes zoster. Although meningitis and encephalitis are well recognized manifestations of neuroinvasive VZV infection, associated autonomic dysfunction remains comparatively underreported, particularly in immunocompetent individuals. Case Presentation: We describe a 66-year-old immunocompetent man who developed VZV meningoencephalitis associated with sacral dermatomal herpes zoster, urinary retention, and bowel dysmotility. Initial symptoms included fever, severe headache, photophobia, and low back pain, with delayed recognition of the characteristic sacral vesicular eruption. The patient subsequently developed encephalopathy and meningeal signs requiring intensive care unit admission. Cerebrospinal fluid analysis demonstrated lymphocytic pleocytosis and markedly elevated protein concentration, and VZV DNA was detected by polymerase chain reaction testing. During hospitalization, the patient developed severe urinary retention and gastrointestinal dysmotility without evidence of mechanical obstruction, raising concern for concurrent autonomic nervous system involvement. Following intravenous acyclovir therapy and supportive management, the patient experienced gradual neurologic and autonomic recovery. Conclusions: This case highlights the potential for multifocal neuroinvasive VZV disease involving both central and autonomic nervous system structures in immunocompetent hosts. Clinicians should maintain awareness that urinary retention and bowel dysmotility may represent clinically significant autonomic manifestations of VZV reactivation, particularly in the setting of sacral dermatomal involvement.
Keywords: varicella-zoster virus; VZV; meningoencephalitis; autonomic dysfunction; neurogenic bladder; bowel dysmotility; neurotropism; immunocompetent host; sacral herpes zoster; neuroinvasive disease varicella-zoster virus; VZV; meningoencephalitis; autonomic dysfunction; neurogenic bladder; bowel dysmotility; neurotropism; immunocompetent host; sacral herpes zoster; neuroinvasive disease

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MDPI and ACS Style

Pyatt, J.; Umaña Mejía, C.A.; Cruz, J.; Baires, F.; Hoffman, H.; Cordero Guerra, J.; Sierra-Hoffman, M.; Hesse, H.; Madril, A.C. Concurrent Central and Autonomic Nervous System Involvement in Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case-Based Mechanistic Analysis. Infect. Dis. Rep. 2026, 18, 58. https://doi.org/10.3390/idr18030058

AMA Style

Pyatt J, Umaña Mejía CA, Cruz J, Baires F, Hoffman H, Cordero Guerra J, Sierra-Hoffman M, Hesse H, Madril AC. Concurrent Central and Autonomic Nervous System Involvement in Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case-Based Mechanistic Analysis. Infectious Disease Reports. 2026; 18(3):58. https://doi.org/10.3390/idr18030058

Chicago/Turabian Style

Pyatt, Jordan, Carlos A. Umaña Mejía, Justice Cruz, Fernando Baires, Helen Hoffman, Joanne Cordero Guerra, Miguel Sierra-Hoffman, Heike Hesse, and Amy C. Madril. 2026. "Concurrent Central and Autonomic Nervous System Involvement in Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case-Based Mechanistic Analysis" Infectious Disease Reports 18, no. 3: 58. https://doi.org/10.3390/idr18030058

APA Style

Pyatt, J., Umaña Mejía, C. A., Cruz, J., Baires, F., Hoffman, H., Cordero Guerra, J., Sierra-Hoffman, M., Hesse, H., & Madril, A. C. (2026). Concurrent Central and Autonomic Nervous System Involvement in Varicella-Zoster Virus Infection in an Immunocompetent Patient: A Case-Based Mechanistic Analysis. Infectious Disease Reports, 18(3), 58. https://doi.org/10.3390/idr18030058

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