Herpes Zoster Meningitis in a Young, Immunocompetent Adult.

BACKGROUND: Varicella-zoster virus is typically encountered in the emergency department (ED) in two forms: varicella (chickenpox) in children and zoster (shingles) in older adults. Zoster is infrequently encountered in young, healthy adults, and neurological complications are extremely rare. CASE REPORT: We describe a case of a previously healthy 36-year-old woman who presented to the ED with fever, nuchal rigidity, and headache 4 days after being diagnosed with herpes zoster and started on oral valacyclovir. Lumbar puncture confirmed herpes zoster meningitis. Despite initiation of antivirals within 48 h of symptom onset, progression to zoster meningitis occurred. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians must be aware that neurological complications of varicella zoster can develop despite initiation of oral antivirals. These patients must be identified in the ED, as admission for intravenous antivirals is indicated.