eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2021-02-23 9 5 278 280 10.12691/ajmcr-9-5-4 AJMCR2021954 article Abdalla Khalil abdallak59@gmail.com 1 Khalil Hossenbux 1 Yusuf Ibidapo 1 Acute Medicine Department, Princess Royal University Hospital, KingĄ¯s College Trust, London, UK Viral meningitis is the most common identified cause of meningitis in the United Kingdom and represents a challenge to diagnose early and a burden on health care service. A young healthy female was admitted to the hospital with a headache, nausea, vomiting, meningeal irritation, and a strong family history of a cerebral aneurysm. She had no fever or rash and her cerebrospinal fluid CSF showed lymphocytic pleocytosis with high protein and normal glucose. Initially, she was treated empirically with antiviral and antibiotics for acute meningitis and her final workup confirmed the varicella zoster viral meningitis. Rarely, Varicella zoster viral meningitis can affect immune-competent patients. It can also rarely present without a skin lesion or fever. Virology study of the cerebrospinal fluid may reveal the diagnosis of viral meningitis early and reduce the health care burden. http://pubs.sciepub.com/ajmcr/9/5/4/ajmcr-9-5-4.pdf viral meningitis Varicella zoster virus immune-competent skin lesions