Fig. 1

Imaging characteristics of VZV encephalitis and vasculitis from brain MRI. A 18-year-old man was admitted to the ICU for fever, headaches and altered consciousness. He underwent a second kidney transplantation 2 years ago. The onset of neurologic symptoms started 2 days before ICU admission and invasive mechanical ventilation was implemented at day 2 for coma. The lumbar puncture revealed acute lymphocytic meningitis and the PCR for VZV was positive. Brain MRI showed multiple recent ischemic lesions of the brain parenchyma (A: white arrows) and vasculitis with multiple stenosis of the circle of Willis arteries (B: red arrows). He was treated with intravenous acyclovir 10 mg/kg/8 h and steroids (methylprednisolone 1 mg/kg). He recovered gradually and was extubated after 4 days of invasive mechanical ventilation. The patient was ultimately discharged alive 8 days after ICU admission