Multifocal VZV vasculopathy with temporal artery infection mimics giant cell arteritis

From the Departments of Neurology (M.A.N., J.L.B., N.K., A.C., A.R., D.G.), Microbiology (D.G.), Ophthalmology (J.L.B.), and Pathology (P.J.B.), University of Colorado School of Medicine, Aurora, CO.
Neurology (Impact Factor: 8.29). 05/2013; 80(22). DOI: 10.1212/WNL.0b013e318294b477
Source: PubMed

ABSTRACT Objective:
To address the incidence of varicella-zoster virus (VZV) infection in patients with biopsy-negative giant cell arteritis (GCA), we examined archived biopsy-negative temporal arteries from subjects with clinically suspected GCA for the presence of VZV antigen.

Formalin-fixed, paraffin-embedded temporal arteries that were pathologically negative for GCA and normal temporal arteries were analyzed immunohistochemically for VZV and herpes simplex virus-1 (HSV-1) antigen.

Five (21%) of 24 temporal arteries from patients who were clinically suspect but biopsy negative for GCA revealed VZV but not HSV-1 by immunohistochemical analysis. Thirteen normal temporal arteries did not contain VZV or HSV-1 antigen. All 5 subjects whose temporal arteries contained VZV antigen presented with clinical and laboratory features of GCA and early visual disturbances.

Multifocal VZV vasculopathy can present with the full spectrum of clinical features and laboratory abnormalities characteristically seen in GCA.

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Available from: April Rempel, May 06, 2015
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    • "The patient was lost to follow-up after April 2010. One-hundred 5-μm sections of the formalin-fixed, paraffin-embedded TA biopsy were cut and every 5th section was immunostained with antibody to VZV as described [1]. Two nonconsecutive sections spanning 350 μm revealed VZV antigen in the adventitia and media (Fig. 2A–B, respectively ). "
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    ABSTRACT: We recently detected varicella zoster virus (VZV) in the temporal arteries (TA) of 5/24 patients with clinically suspect giant cell arteritis (GCA) whose TAs were GCA-negative pathologically; in those GCA-negative, VZV+TAs, virus antigen predominated in the arterial adventitia, but without medial necrosis and multinucleated giant cells [1]. During our continuing search for VZV antigen in GCA-negative TAs, in the TA of one subject, we found abundant VZV antigen, as well as VZV DNA, in multiple regions (skip areas) of the TA spanning 350μm, as well as in skeletal muscle adjacent to the infected TA. Additional pathological analysis of sections adjacent to those containing viral antigen revealed inflammation involving the arterial media and abundant multinucleated giant cells characteristic of GCA. Detection of VZV in areas of the TA with pathological features of GCA warrants further correlative pathological-virological analysis of VZV in GCA.
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