Treatment of Herpes Zoster-Associated Neurological Complications with High-Dose Intravenous Ascorbic Acid: Two Case Reports
Bibliographic record
Abstract
Background: Herpes zoster (HZ), caused by reactivation of the varicella zoster virus, can be associated with serious and difficult-to-treat neurological complications, especially in immunocompromised people. Ascorbic acid (Asc) administered intravenously in high doses has been shown to possess immunomodulatory and anti-inflammatory effects. Here, we report two cases of patients: 1) with postherpetic neuralgia (PHN) and 2) with myelitis presumably caused by HZ, who were successfully treated using this approach as adjunctive therapy. Regarding HZ-related myelitis, this is the first reported case to our knowledge. Cases Presentation: A 72-year-old male came to the clinic with treatment-resistant postherpetic trigeminal neuralgia and cervical sympathetic ganglionitis. He rated pain intensity as 10 on the visual analogue scale (VAS). The second patient, a 34-old female, was referred with a preliminary diagnosis of cervical myelitis. She suffered from right-sided sensory-motor impairments and urinary retention. Previous treatment did not result in improvement. Neurological and MRI findings were typical of cervico-thoracic myelitis associated with right-sided hemiparesis. Two months before the onset of the first symptoms, she developed a HZ rash in the cervico-occipital region on the right, suggesting an association between HZ and myelitis. Both patients received two courses of Asc (each course consisting of 20 g administered intravenously daily for five days). The male noted a gradual pain relief from the initial 10 to 2 points on the VAS, with only a slight increase at night. In the female's case, hemiparesis regressed and bladder function was restored. Only mild neurological deficits remained. Conclusion: This study supports the use of high-dose intravenous Asc as adjunctive therapy for HZ-associated neuralgia and myelitis, especially in treatment-resistant cases. In order to determine the optimal dosages, it is necessary to perform clinical trials. Furthermore, it would be interesting to study the potential use of Asc therapy for other HZ-related complications.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.004 |
| Meta-epidemiology (narrow) | 0.003 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.007 | 0.003 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".