Fatal intracerebral hemorrhage in a pregnant woman following varicella zoster virus infection: a rare neurological complication.

Varicella zoster virus (VZV) infection is usually mild in childhood but can be severe in adults, particularly in pregnancy, leading to significant complications. Neurological complications are relatively uncommon; in particular, vasculopathy resulting in stroke and hemorrhage is very rare. This case report describes a rare and lethal complication of primary varicella zoster virus (VZV) infection in a pregnant woman at 34 weeks of gestation. The patient, who presented with vomiting and altered sensorium, was diagnosed on postmortem with intracerebral hemorrhage (ICH) due to VZV-induced vasculitis. Despite negative findings for common causes like antiphospholipid syndrome, hypertension, and hematological disorders, postmortem and histopathological examinations yielded distinct neuropathological changes, including middle cerebral artery vasculitis and intraventricular hemorrhage. This case underscores the importance of vigilant monitoring and early detection of VZV-related complications during pregnancy and the role of neuropathology in establishing the cause of death.