Prolonged Vzv IgM Serum Seropositivity in Multiple Sclerosis Is Associated with New Sensory Symptoms, a Case Series
Objectives: Do subclinical active VZV infections complicate RRMS?
Methods: RRMS patients with new sensory symptoms were examined and had their serum tested for VZV IgM to assess for subclinical VZV activity.
Results: Case series of 5 patients:
60 yr old woman with RRMS for 7 yrs with brain and cervical cord lesions, started complaining of tingling on her left shoulder, no rash. She takes Copaxone and lab testing revealed elevated serum VZV IgM titers that remain positive 15 months later despite valtrex treatment and prophylaxis. She continues to have rare shoulder paresthesias.
35 yr old woman with RRMS for 9 yrs on Avonex and Solumedrol therapy with lesions throughout the brain and spinal cord, started having worsening leg weakness and received extra solumedrol which helped her leg weakness, but then resulted in left face buzzing. No rash, but testing shows high VZV IgM titers. Despite valtrex treatment, elevated VZV IgM titers persisted for 7 months, and recurs. She still occasionally feels buzzing there.
58 yr old man with RRMS for 6 years with lesions throughout the brain and spinal cord, on Betaseron and pulse steroids, started having worsening leg weakness and received extra steroids that seemed to help. A few months later however, he complained of new burning neuralgia in his feet. Concurrently had first onset gential herpes at this time. Blood tests revealed elevated VZV IgM titers that stayed positive over 3 years despite continuous valtrex treatment. He has complained of 2-3 times per year of new onset intense burning neuralgia type sensations.
45 yr old man with RRMS for 1 year on Copaxone with lesions in brain and spinal cord, was in a MVA and had a relapse with limb weakness and strong right thoracic MS hug symptoms--as he had on his initial MS attack. Serum tests revealed elevated VZV IgM titers that were treated with valtrex and he also received IV solumedrol 3 grams with resolution of his symptoms. His abnormally elevated VZV IgM titers persisted over 7 months and he did suffer from a possible shingles outbreak in the gluteal region 4 months after his MS relapse.
55 yr old woman with RRMS with secondary progression for 3 years with multiple sclerosis lesions throughout the brain and spinal cord on Avonex, had an outbreak of left upper thoracic possible shingles treated about 1.5 years into her diagnosis. Months later, she started having a tightness hug feeling in her upper thoracic area and serum lab tests revealed elevated VZV IgM titers. Her "hug" symptoms persist over 14 months later as do her abnormal VZV IgM titers.
Conclusions: This case series suggests that sustained high VZV IgM serum titers may not be uncommon in patients with RRMS experiencing sensory symptoms and that further prospective investigation for the role of VZV in sensory MS relapses should be considered.