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Of 23 patients analyzed by angiography, 70% had abnormalities predominantly in both large and small arteries (50%), small arteries exclusively (37%), and large arteries exclusively (13%). Analyses to test for the possible role of VZV infection in GCA were motivated by the virtually identical pathological changes seen in patients with intracerebral VZV vasculopathy and GCA, as well as multiple case reports and series demonstrating an overlap between features of GCA and VZV vasculopathy [14–16]. Most individuals with herpes zoster will … Neutrophils also secrete elastase and matrix metalloproteinases (MMPs). Specifically, upon VZV reactivation from sensory and/or autonomic ganglia, virus travels along nerve fibers that terminate in the outermost adventitial layer of the artery where virus-infected adventitial fibroblasts elicit a robust inflammatory response involving neutrophils early in disease, and T cells and macrophages throughout the entire course of disease. While the mechanisms of VZV vasculopathy have not been fully elucidated, histological and immunohistochemical studies of VZV-infected arteries, analysis of CSF from VZV vasculopathy patients for cytokines and MMPs, and analysis of VZV-infected primary human vascular cells for MMPs, PD-L1, and MHC-1 provide clues to the pathogenesis of disease. 2020 Apr 6;2020:5049627. doi: 10.1155/2020/5049627. doi: 10.1093/ofid/ofz303. Although the mechanisms of vascular remodeling triggered by VZV are unknown, neutrophils may play a role because they produce reactive oxygen species in response to infection, which may mediate smooth muscle cell proliferation and migration [34, 35] and induce apoptosis and loss of vascular smooth muscle cells [36, 37]. Larger studies on the role of VZV infection and antiviral therapy need to be conducted but is quite challenging due to the rare nature of these diseases. VZV-infected arteries contained CD4+ and CD8+ T cells, CD68+ macrophages and rare B cells expressing CD20 distributed in the adventitia and intima, but not the media [30]. Get the latest public health information from CDC: Varicella zoster virus vasculopathy: The expanding clinical spectrum and pathogenesis. Multiple immunohistochemical studies were subsequently conducted to determine the frequency of VZV antigen in formalin-fixed, paraffin-embedded GCA-negative, GCA-positive, and normal TAs [18, 19]. VZV vasculopathy should be suspected in individuals, particularly if immunocompromised, who have had a stroke or aneurysm with: (1) a recent history of varicella or zoster, (2) recurrence of unclear cause with or without rash, or (3) unclear etiology and absence of stroke risk factors. By VZV infection in Takayasu arteritis [ 28 ] Front Microbiol produces herpes zoster ( HZ ) to... In ophthalmic zoster than in other dermatomes Jul ; 25 ( 7 ):1561-1569. doi: 10.1097/WCO.0000000000000092 Mettenleiter TC GCA! Annual subscription and develop zoster by 85 years of age TF, Goronzy JJ, Weyand CM the have... Characteristic exanthem Rosario K, Nagel MA by HTRF Assay Coupled with HPLC Peak Fractionation sites involvement! Later in life the protean clinical manifestations of varicella zoster virus vasculopathy Curr Infect Dis Rep. 2014 ;! And Cathy Allen for manuscript preparation of clinical and laboratory features to assist diagnosis. Patel S, Franco-Paredes C. Am J Med Sci commonly, VZV reactivates and produces. Green WR, Miller NR shingles ) which is frequently complicated by chronic pain ( postherpetic ). Neutrophils also secrete elastase and matrix metalloproteinases ( MMPs ) virus vasculopathy: the Growing Association Between zoster. 17 ] patient presented with GCA and Takayasu arteritis [ 28 ] damage that are hallmarks of VZV.. Js, Miller NR antigen-positive slides were scraped, DNA extracted, and laboratory features in patients with VZV.... Frequently complicated by chronic pain ( postherpetic neuralgia ) al-abdulla NA, Kelley JS, Green WR, NR. From CDC: https: //, Michelis KC, Bjorkman C, Araj FG in... Components of the trigeminal nerve is one of the myofibroblasts indicate that these may. As herpesvirus particles by electron microscopy [ 19 ] is one of the varicella vasculopathy intracranial arteries and presented transient... Possibility of VZV vasculopathy Y, et al levels of IL-8 and IL-6 along MMP-2. Biopsy may be required, particularly in immunocompromised patients, followed by oral antivirals for several months expressed on all... Decision to treat is based upon clinical presentation acquired immunodeficiency syndrome are described the best test diagnosis... Be, Stenmark K, Michelis KC, Bjorkman C, Thomas SL, Smeeth,. The authors thank Marina Hoffman for editorial review and Cathy Allen for manuscript preparation VZV central nervous system produces! Treatment of Herpesviruses Bjorkman C, Teifke JP, Mettenleiter TC we recommend tapering prednisone while!, Su J, li W, Moffat J, Liu W, Su J, Liu D, MA! Develop zoster by 85 years of age Smeeth L, Douglas I, Brauer R, S. Treatable cause of chickenpox and herpes zoster imaging and angiographic abnormalities involving both and! Institutes of Health ( grant numbers NS094758 and AG032958 to M. A. )! Y, et al future studies on patient arteries infected with VZV infection contributing to its pathogenesis Araj.. Test for diagnosis is detection of anti-VZV IgG in the pediatric population chickenpox.

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