Bilateral brachial neuritis secondary to varicella reactivation in an HIV-positive man.

[neuralgic amyotrophy]

We present the case of a 48 -year -old HIV-positive man , who developed acute onset of pain in both upper limbs associated with proximal weakness and distal paraesthesia . Eight weeks prior to this presentation he had had varicella zoster affecting his right S 1 dermatome . CD 4 count was 355 cells /mm (3 ) and he was antiretroviral therapy (ART ) naive . Power was 0 /5 proximally and 4 /5 distally in the upper limbs . Reflexes were absent and there was sensory loss in the C 5 , C 6 and T 1 dermatomes . Cerebrospinal fluid (CSF ) examination showed a lymphocytosis with low glucose ; however , CSF Mycobacterium tuberculosis (TB ), and herpes simplex virus polymerase chain reaction (HSV PCR ) were negative as was syphilis serology . Electromyography showed marked motor axonal loss . Magnetic resonance imaging (MRI ) did not show any cervical spinal lesion . Varicella zoster virus (VZV ) PCR was positive in the CSF . He was treated with high -dose intravenous aciclovir with good resolution of his syndrome over time and was commenced on ART . We believe this to be the first case report of varicella reactivation causing bilateral neuralgic amyotrophy in an HIV-positive patient .