Multifocal VZV vasculopathy with temporal artery infection mimics giant cell arteritis

Neurology. 2013 May 28;80(22):2017-21. doi: 10.1212/WNL.0b013e318294b477. Epub 2013 May 1.


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.

Methods: 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.

Results: 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.

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

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Diagnosis, Differential
  • Female
  • Giant Cell Arteritis / diagnosis
  • Giant Cell Arteritis / pathology*
  • Giant Cell Arteritis / virology*
  • Herpes Zoster / diagnosis*
  • Herpes Zoster / epidemiology
  • Herpes Zoster / pathology
  • Herpesvirus 3, Human / pathogenicity*
  • Humans
  • Incidence
  • Inflammation / diagnosis
  • Inflammation / pathology
  • Inflammation / virology
  • Male
  • Middle Aged
  • Temporal Arteries / pathology*
  • Temporal Arteries / virology*
  • Vascular Diseases / diagnosis
  • Vascular Diseases / pathology*
  • Vascular Diseases / virology*