一位高齡肝硬化病人之水痘帶狀疱疹病毒中樞神經感染

Varicella Zoster Virus Central Nervous System Infection in an Elderly Patient with Liver Cirrhosis

水痘帶狀疱疹病毒（Varicella Zoster Virus，VZV）為具神經親和性的DNA病毒，於免疫功能低下或高齡者中，可再活化並侵犯中樞神經系統，導致腦膜炎或腦炎。本案例為一位83歲男性，具慢性C型肝炎合併肝硬化、慢性腎臟病及高血壓等病史，因跌倒後出現左眼腫脹與意識混亂入院。影像學顯示無急性病灶，初步診斷為帶狀疱疹性眼病，並給予Acyclovir治療。病程中因意識變差，進行腰椎穿刺，腦脊髓液檢驗出VZV核酸，確診為VZV中樞神經感染。調整抗病毒劑量後病情逐漸改善，第11天退燒，第33天康復出院。此案例顯示VZV中樞神經感染可表現為非典型症狀，特別是在免疫功能低下或高齡病人。文獻指出VZV腦炎死亡率約5-20%，完全神經學恢復率約33-49%。早期診斷與即時靜脈注射Acyclovir為改善預後關鍵。臨床上應於高危險族群出現神經學異常時，儘早進行腰椎穿刺與病毒檢測，以降低死亡與神經後遺症風險。

Varicella Zoster Virus (VZV) is a neurotropic DNA virus that can reactivate in immunocompromised or elderly individuals and invade the central nervous system (CNS), leading to meningitis or encephalitis. We report the case of an 83-year-old man with a medical history of chronic hepatitis C with liver cirrhosis, chronic kidney disease, and hypertension, who was admitted due to left periorbital swelling and altered consciousness after a fall. Brain imaging revealed no acute lesions. He was initially diagnosed with herpes zoster ophthalmicus and treated with acyclovir. During hospitalization, his mental status deteriorated, prompting lumbar puncture. Cerebrospinal fluid analysis detected VZV DNA, confirming VZV CNS infection. After adjustment of the antiviral dosage, his condition gradually improved; he became afebrile on day 11 and was discharged with full recovery on day 33. This case highlights that VZV CNS infection may present with atypical manifestations, particularly in elderly or immunocompromised patients. Previous reports indicate a mortality rate of approximately 5–20% and complete neurological recovery in 33–49% of patients with VZV encephalitis. Early diagnosis and prompt intravenous acyclovir administration are crucial for improving outcomes. Clinicians should perform early lumbar puncture and viral testing in high-risk patients presenting with neurological abnormalities to reduce mortality and neurological sequelae.