209 - A Rare and Underdiagnosed Cause of Myeloradiculitis: Varicella Zoster Virus

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

YK

Yanni G. Kevas, MD

Resident Physician
Burke Rehabilitation Hospital
White Plains, New York, United States

Co-Author(s)

SA

Sophia Antimisiaris, DO, MPH

Resident Physician
Burke Rehabilitation Hospital
White Plains, New York, United States
JG

Jason Georgekutty, DO

Attending Physiatrist
Burke Rehabilitation Hospital
roslyn heights, New York, United States

Submitter(s)

YK

Yanni G. Kevas, MD

Burke Rehabilitation Hospital
White Plains, New York, United States

Case Diagnosis: Myeloradiculitis secondary to Varicella Zoster Virus

Case Description: The patient is a 62-year-old female who presented with progressively worsening ascending leg weakness and numbness. Her exam was notable for lower extremity weakness, absent lower extremity reflexes and absent rectal tone. She displayed worsening respiratory status concerning for Guillain-Barre Syndrome and was started on intravenous (IV) immunoglobulin and empiric antibiotics. CT and CTA of the head and neck were negative. MRI of the thoracic and lumbar spine showed abnormal T2 signal at T10-T11 and mild diffuse enhancement of the cauda equina nerve roots. Lumbar puncture was notable for Varicella Zoster Virus (VZV) immunoglobulin G antibody. IV acyclovir and methylprednisolone were initiated with small clinical improvements. Repeat MRI of the thoracic spine showed interval improvement. Nerve conduction study revealed lumbosacral radiculitis without evidence of demyelinating disease, polyneuropathy, or myopathy. Her strength and function continued to improve with physical and occupational therapy at acute rehab.

Discussions: VZV is an established, but often under-recognized cause of acute myeloradiculitis. Typically, VZV infection presents with radiating pain in a dermatomal pattern followed by a characteristic vesicular rash in that same distribution. Given this classic presentation, VZV is not commonly included in the differential for radicular presentations. Neurological complications are rare in VZV infections, occurring in only 0.01-0.03%. Furthermore, only 0.3% of those complications are accounted for by transverse myelitis. MRI findings in VZV radiculitis include abnormal enhancement in affected nerve roots as well as gray matter columns if there is a myelopathic component. Given that these findings are nonspecific, cerebrospinal fluid (CSF) analysis is an important diagnostic tool to confirm the presence of VZV DNA.

Conclusions: This patient with a rare etiology of myeloradiculitis made incremental improvements in function with prompt medical care, proper diagnosis, and intensive physical and occupational therapy.