Varicella zoster vasculopathy presenting as bilateral subdural haematoma in an infant: case report of a rare case and literature review.

backgroundVaricella-zoster virus (VZV) infection is typically benign in infants but may rarely cause neurological complications. The occurrence of chronic subdural haematoma following VZV infection in children has not previously been reported. CASE DESCRIPTION: We report the case of a 6-month-old male infant who developed chicken pox with fever, irritability, and generalized vesicular rash. His rash and fever settled over 2 weeks, but he had persistent irritability, decreased feeding, intermittent vomiting, regression of developmental milestones, and developed progressive weight loss (50th to 9th centile). At 7 months, due to vomiting and persisting irritability, he was evaluated and found to have bilateral subdural collections resembling those typically seen following non-accidental injury. His subdural collections increased over next 3 weeks and he developed a tense fontanelle; therefore he underwent an ultrasound-guided trans-fontanelle aspiration yielding blood-stained fluid resulting in transient improvement. Rapid re-accumulation of the subdural collections necessitated bilateral burr-hole evacuation with creation of subdural pockets. Subsequent recurrence of the subdural collections was finally managed with a right-sided subduro-peritoneal shunt. His subdural fluid tested positive for VZV IgG which was indicative of previous VZV CNS encephalitis or vasculitis. On follow-up, the child recovered fully, regaining weight and developmental milestones.

conclusionBilateral subdural haematoma following VZV infection in infancy is a rare and delayed but life-threatening complication which requires prompt recognition and intervention. It can mimic findings seen following non-accidental injury. Prolonged neurological symptoms following VZV infection should raise the possibility of intracranial complications and needs prompt investigation and management.