Transsynaptic spread of varicella zoster virus through the visual system: a mechanism of viral dissemination in the central nervous system.
We report a patient with pathologic evidence of anterograde spread of varicella zoster virus (VZV) through the visual system. A 29-year-old homosexual man developed the acquired immunodeficiency syndrome (AIDS) 2 months before the onset of left herpes zoster ophthalmicus. During the next 11 months, the zoster infection progressed to involve the left eye, with resultant keratitis, iritis, retinitis, and eventual blindness. Later, the patient developed bilateral blindness, left hemiparesis, and fatal pneumonia. At autopsy, the brain revealed destruction of the visual system and adjacent structures, with sparing of the remainder of the brain. Glial cells near the areas of necrosis showed Cowdry type A intranuclear inclusions. In situ hybridization with probes to VZV nucleic acid sequences were positive in the necrotic brain and retinal areas. Hybridization with probes to cytomegalovirus, herpes simplex virus type II, human immunodeficiency virus, and Epstein-Barr virus were negative. Electron microscopy revealed characteristic herpes group nucleocapsids. This case provides insight into the mechanisms of virus dissemination and the production of encephalitis.
Rostad
S W
SW
Department of Pathology, University of Washington School of Medicine, Seattle 98195.
Olson
K
K
McDougall
J
J
Shaw
C M
CM
Alvord
E C
EC
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications; D000328:Adult; D001696:Biomechanical Phenomena; D001921:Brain / Q000382:microbiology* / Q000473:pathology; D006563:Herpes Zoster Ophthalmicus / Q000150:complications / Q000382:microbiology; D014645:Herpesvirus 3, Human / Q000502:physiology*; D006801:Humans; D008297:Male; D008854:Microscopy, Electron; D009336:Necrosis; D012160:Retina / Q000473:pathology; D013569:Synapses / Q000382:microbiology* / Q000648:ultrastructure; D014795:Visual Pathways / Q000382:microbiology* / Q000473:pathology / Q000648:ultrastructure