Abstract
BACKGROUND Varicella-zoster virus (VZV) encephalitis is a commonly reported form of encephalitis that clinically manifests as skin lesions, fever, headache, and neuropsychiatric symptoms. We present a case of a patient with VZV encephalitis complicated by cerebral hemorrhagic transformation, characterized by high levels of inflammation and protein in the cerebrospinal fluid. The aim is to highlight the risk of hemorrhagic transformation associated with VZV encephalitis. CASE REPORT The patient exhibited scattered herpes lesions on the head, neck, and chest. Notably, the cerebrospinal fluid (CSF) protein concentration was markedly elevated at 9049.3 mg/L, with a CSF white blood cell count of 950×10⁶/L, of which lymphocytes constituted 80%. MRI revealed abnormal signal foci in the bilateral temporal lobes and the right frontal lobe, consistent with findings associated with herpes encephalitis. Despite initial treatment with anti-inflammatory agents, acyclovir antiviral, and antiepileptic medications, the patient did not show improvement, prompting the addition of double filtration plasmapheresis. However, the patient experienced hemorrhagic transformation and succumbed to the illness. CONCLUSIONS This case highlights the challenge of managing VZV encephalitis in the context of significant inflammation and protein elevation in the CSF, and underscores the need for further research into more effective therapeutic strategies for this rare but potentially devastating condition.