As a common cause of viral encephalitis, varicella-zoster virus (VZV) may invade the central nervous system of immunosuppressed patients during reactivation. Herein, we report a rare case of an immunocompetent patient with VZV encephalitis who developed severe hyponatremia and was considered to have a suspected primary infection. The patient was diagnosed with the support of second-generation sequencing and had persistent hyponatremia after being cured. Although rare, this case suggests that VZV encephalitis may occur in unexpected patients and present with unusual clinical manifestations, requiring advanced detection methods and clinical expertise for resolution.
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