1. Presented by Julia Gales, M.D. and reviewed by Heba Mostafa, M.B.B.Ch., Ph.D.

A patient with no significant medical history presents to the emergency department with a persistent  headache, neck stiffness, and transient speech issues. A week before the onset of the headache, the patient noted back pain with an associated rash.

There were no findings on head CT or MRI. A lumber puncture was performed:

CSF cell count:
Appearance: Clear
Color: No color
White blood count: 1,059 cu/mm
Red blood count: 1,000 cu/mm

 CSF differential:Lymphocytes absolute #: 949 cu/mm
Neutrophils absolute #: 10 cu/mm
Monocytes absolute #: 51 cu/mm
Eosinophils absolute #: 0 cu/mm
Blasts absolute #: 0 cu/mm

Rash of a similar patient:
Question
Where does the patient’s virus typically reside in a dormant state following initial infection?