Open Access Highly Accessed Open Badges Case report

Varicella zoster virus infection presenting as isolated diplopia: a case report

Raffaella Pisapia1*, Alessia Rianda1, Andrea Mariano1, Angela Testa1, Simonetta Galgani2, Laura Vincenzi1, Amina Abdeddaim1, Alessandra Oliva1 and Pasquale Narciso1

Author affiliations

1 Clinical Department, First Division, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Via Portuense 292, 00149, Rome, Italy

2 Neuroscience Department, “San Camillo Forlanini” hospital, Rome, Italy

For all author emails, please log on.

Citation and License

BMC Infectious Diseases 2013, 13:138  doi:10.1186/1471-2334-13-138

Published: 15 March 2013



Involvement of trochlear nerve during Varicella Zoster Virus (VZV) Infection has been rarely described, and always in association with skin rash.

Case presentation

We describe the case of a patient with VZV infection presenting as isolated diplopia due to fourth cranial nerve palsy. The diagnosis has been obtained through the application of a standardized molecular diagnostic panel, and diplopia resolved after specific antiviral and corticosteroid therapy.


This case evidences that clinicians should be aware of atypical VZV infection, even in the absence of the typical skin rash.

Varicella zoster virus; Cranial nerve palsy; Molecular diagnosis; Clinical awareness