Atypical varicella zoster virus CNS infections: Diagnostic challenges and the role of multiplex PCR

This study highlights the prevalence of atypical presentations in VZV CNS infections, including cases without cutaneous manifestations and those lacking cerebrospinal fluid pleocytosis. The findings underscore the critical role of multiplex PCR in diagnosing VZV meningitis and meningoencephalitis, particularly in cases with atypical presentations. The study also reveals the more severe nature of meningoencephalitis, as evidenced by longer hospital stays. These results challenge traditional diagnostic approaches and emphasize the need for a high index of suspicion for VZV in all cases of suspected viral CNS infection, regardless of initial clinical or cerebrospinal fluid findings.