eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2020-06-17 8 10 328 331 10.12691/ajmcr-8-10-2 AJMCR20208102 article Nyein Nyein Thaw Dar 1 Ismail Oladeji Malik 1 Robert Miguel Thomas 1 Maria Madah 1 Aye Mar Aung 1 Dora Izaguirre-Anariba 1 Simona Bratu 1 Luqman Salahudeen salahudl@nychhc.org 1 Department of Medicine, Harlem Hospital, New York, NY 10037, USA Varicella zoster viral infection commonly presents as ¡°chickenpox¡± in children and ¡°shingles¡± in adults which may be complicated by meningitis in the immunocompromised but very rarely in the immunocompetent. Also, most reported cases of zoster meningitis were associated with the development of crops of vesicular rash at the cranial or cervical dermatomal levels. Here, we present a case of a 55-year-old African man with history of chronic low back pain who presented with frontal headache, fever and rash of the left lower extremity of two days¡¯ duration. He had no neck stiffness, neck pain or mental status changes on presentation. Brain imaging revealed no significant findings but Cerebrospinal fluid (CSF) examination showed lymphocytic pleocytosis and patient was promptly started on IV acyclovir. Biofire CSF analysis detected presence of Varicella Zoster virus (VZV). In this clinical encounter, leg rash and non-specific symptoms of fever and headache in the absence of meningism, confusion or focal neurologic deficits is an unusual presentation of VZV meningitis which may delay diagnosis. Hence, a high index of suspicion and early treatment for neurologic complications of VZV like meningitis is required in order to prevent lethal or severe long-term neurologic deficits in patients. http://pubs.sciepub.com/ajmcr/8/10/2/ajmcr-8-10-2.pdf Varicella Zoster virus meningitis shingles rash headache