Varicella Zoster Encephalitis in an Immunocompetent Middle-Aged Female with Benign Neurological Presentation

Varicella Zoster Virus (VZV) is a neurotropic human herpesvirus that typically presents as herpes zoster following reactivation of latent infection. Central nervous system involvement such as encephalitis is uncommon and is more frequently described in immunocompromised individuals. Increasing use of polymerase chain reaction (PCR)-based diagnostics has enabled improved recognition of VZV-related neurological disease in immunocompetent hosts. We describe a middle-aged immunocompetent female who presented with a 15-day history of persistent headache associated with vomiting and low-grade fever. Examination revealed vesicular eruptions in the T8–T9 dermatomes, while neurological examination and neuroimaging were normal. Cerebrospinal fluid (CSF) analysis demonstrated lymphocytic pleocytosis, elevated protein, and low glucose levels, initially suggesting tubercular meningitis. However, microbiological studies were negative, and CSF PCR confirmed VZV infection. The patient was treated with intravenous acyclovir for 12 days along with a short course of corticosteroids, resulting in complete clinical recovery. This case highlights that VZV encephalitis can occur in immunocompetent individuals and may present with subtle neurological findings and normal imaging. Early suspicion, timely CSF PCR testing, and prompt antiviral therapy are critical in achieving favorable outcomes. Increased awareness and strengthened vaccination strategies may help reduce the burden of this preventable neurological complication.