Herpes zoster vasculitis presenting as giant cell arteritis with bilateral internuclear ophthalmoplegia

Am J Ophthalmol. 2002 Dec;134(6):912-4. doi: 10.1016/s0002-9394(02)01811-1.


Purpose: To present a case of herpes zoster vasculitis presenting as giant cell arteritis.

Design: Interventional case report.

Methods: A 77-year-old woman presented with sudden onset of diplopia associated with temple headaches and a previous history of herpes zoster ophthalmicus. A temporal artery biopsy was obtained and in-situ hybridization performed for herpes zoster DNA.

Results: The patient presented with a bilateral internuclear ophthalmoplegia. Initial diagnostic evaluation, including erythrocyte sedimentation rate, C-reactive protein, and temporal artery biopsy, was consistent with giant cell arteritis. However, in-situ hybridization of the temporal artery specimen was positive for herpes zoster DNA.

Conclusions: Herpes zoster vasculitis may mimic giant cell arteritis and should be considered in the differential of any patient with presumed giant cell arteritis with suspicious findings, central nervous system involvement, or previous herpes zoster infection.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Aged
  • DNA, Viral / analysis
  • Diagnosis, Differential
  • Diplopia / etiology
  • Eye Movements
  • Female
  • Giant Cell Arteritis / diagnosis*
  • Giant Cell Arteritis / etiology
  • Headache / etiology
  • Herpes Zoster Ophthalmicus / complications
  • Herpes Zoster Ophthalmicus / diagnosis*
  • Humans
  • In Situ Hybridization
  • Ocular Motility Disorders / diagnosis*
  • Ocular Motility Disorders / etiology
  • Temporal Arteries / pathology
  • Temporal Arteries / virology
  • Visual Acuity


  • DNA, Viral