title: Varicella zoster virus ischemic optic neuropathy and subclinical temporal artery involvement.
abstract: OBJECTIVE
  To demonstrate varicella zoster virus (VZV) infection in an asymptomatic extracranial (temporal) artery in a patient with ischemic optic neuropathy produced by VZV vasculopathy in whom the pathological changes were mistakenly identified as giant cell arteritis.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Teaching hospital, pathology and virology laboratory.
  
  
  METHODS
  An 80-year-old man with left ophthalmic distribution zoster who developed left ischemic optic neuropathy.
  
  
  METHODS
  An ipsilateral temporal artery biopsy revealed inflammation that was mistakenly identified as giant cell arteritis. The patient was initially treated with steroids but his condition did not improve. When the diagnosis of VZV vasculopathy was confirmed virologically and the patient was treated with intravenous acyclovir, his vision improved.
  
  
  RESULTS
  Pathological and virological studies provided proof of VZV vasculopathy in the asymptomatic temporal artery. Varicella zoster virus antigen was abundant in arterial adventitia and scattered throughout the media. With intravenous antiviral therapy, the patient's vision improved.
  
  
  CONCLUSIONS
  Although in previously studied patients who died of chronic VZV vasculopathy after 10 to 12 months, VZV antigen was present exclusively in the intima, collective analyses of chronic cases and the asymptomatic VZV-infected temporal artery suggest that virus enters arteries through the adventitia and spreads transmurally to the intima.
authors.affiliation: Department of Neurology, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Salazar
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Russman
authors.forename: Maria A
authors.initials: MA
authors.lastname: Nagel
authors.forename: Randall J
authors.initials: RJ
authors.lastname: Cohrs
authors.forename: Ravi
authors.initials: R
authors.lastname: Mahalingam
authors.forename: D Scott
authors.initials: DS
authors.lastname: Schmid
authors.forename: Bette K
authors.initials: BK
authors.lastname: Kleinschmidt-DeMasters
authors.forename: Eve M
authors.initials: EM
authors.lastname: VanEgmond
authors.forename: Don
authors.initials: D
authors.lastname: Gilden
mesh_terms: D000369:Aged, 80 and over; D003937:Diagnosis, Differential; D006562:Herpes Zoster / Q000175:diagnosis* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D018917:Optic Neuropathy, Ischemic / Q000175:diagnosis* / Q000821:virology; D013699:Temporal Arteries / Q000473:pathology* / Q000821:virology; D014657:Vasculitis / Q000175:diagnosis / Q000821:virology