Diplopia as isolated presentation of varicella zoster central nervous system reactivation

Here, we report a patient who developed diplopiasecondary to a right cranial nerve III and IV palsy, as well asfever and headache. Cerebrospinal fluid analysis (CSF) showedhigh varicella-zoster virus (VZV)-DNA viral load(>300,000,000 copies/ml). VZV antibodies in CSF was≥1:16. Diagnosis of neurological reactivation of VZV infectionwas made without the presence of characteristic vesicular rash.Quantitative real-time PCR for VZV and intrathecal dosage ofVZV IgM and IgG should be performed in cases suspected forviral encephalitis and also in all patients with not otherwiseattributable cranial nerve lesions.