Atypical Manifestation of VZV Infection in a Vaccinated Immunocompetent Adult

Table 4

Timeline of clinical events.

Day 0	Fatigue, headache, nausea, vomiting, and neck stiffness
Day 1	The patient was started on IV vancomycin and ceftriaxone. CT head was unremarkable. A lumbar puncture was performed in the emergency room which was suggestive of aseptic meningitis. IV acyclovir started.
Day 2	Patient’s headache, nuchal rigidity, nausea, and vomiting significantly improved. Afebrile. CSF PCR positive for VZV. IV vancomycin and ceftriaxone discontinued. The patient continued to be on IV acyclovir
Day 3	Near complete resolution of symptoms. Afebrile. IV acyclovir continued
Day 4	Asymptomatic, afebrile. On IV acyclovir
Day 5	Completed five days of IV acyclovir and discharged home on oral valacyclovir
Day 16	Completed nine days of oral valacyclovir; followed up with primary care provider