TITLE:
Behavioural Shift as a Subtle Mental Change Occurring in a Case of Rheumatoid Arthritis Experiencing Zoster Encephalitis
AUTHORS:
Shweta Thadeshwar, Shiksha Upadhyaya, Renaldo Pavrey
KEYWORDS:
Cognitive Change, Behavioural Shift, Encephalitis, Varicella Zoster, Emergency Department
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.14 No.2,
June
8,
2026
ABSTRACT: Primary varicella (chickenpox) and herpes zoster (shingles) are caused by the highly contagious varicella zoster virus (VZV). Due to underlying immunological dysfunction, people with rheumatoid arthritis (RA) may be more vulnerable to serious infection. A 52-year-old woman with rheumatoid arthritis, who was receiving hydroxychloroquine and sulfasalazine, is the subject of our case study. She had a broad vesicular rash, subtle cognitive difficulties, and VZV hepatitis, a known complication of disseminated infection. Through positive immunoglobulin M (IgM), immunoglobulin G (IgG), and polymerase chain reaction (PCR) detection of VZV deoxyribonucleic acid (DNA) in blood and cerebrospinal fluid (CSF), laboratory studies verified the spread of VZV. Our case highlights behavioral shift as a unique presentation of VZV encephalopathy. An interdisciplinary approach continues to be important in the management of such complicated cases, with timely interventions and better outcomes.