title: Biopsy-negative, varicella zoster virus (VZV)-positive giant cell arteritis, zoster, VZV encephalitis and ischemic optic neuropathy, all in one.
abstract: A 72-year-old man developed clinical features of giant cell arteritis (GCA) and ipsilateral ophthalmic-distribution zoster, followed within 2 weeks by VZV encephalitis and 2 months later by ischemic optic neuropathy. Temporal artery biopsy was histopathologically negative for GCA, but contained VZV antigen and VZV DNA in multiple non-contiguous (skip) areas. The collective clinical and laboratory findings revealed a remarkably close temporal association of zoster, multifocal VZV vasculopathy with temporal artery infection, biopsy-negative VZV-positive GCA and VZV encephalitis.
authors.affiliation: Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Tiago
authors.initials: T
authors.lastname: Teodoro
authors.affiliation: Department of Neuropathology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Nagel
authors.affiliation: Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Ruth
authors.initials: R
authors.lastname: Geraldes
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Teresa
authors.initials: T
authors.lastname: White
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Ravi
authors.initials: R
authors.lastname: Mahalingam
authors.affiliation: Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Paulo
authors.initials: P
authors.lastname: Batista
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Wellish
authors.affiliation: Department of Neuropathology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Jose
authors.initials: J
authors.lastname: Pimentel
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Nelly
authors.initials: N
authors.lastname: Khmeleva
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Anna
authors.initials: A
authors.lastname: Heintzman
authors.affiliation: Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Luísa
authors.initials: L
authors.lastname: Albuquerque
authors.affiliation: Department of Pathology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Boyer
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Alexander
authors.initials: A
authors.lastname: Choe
authors.affiliation: Department of Neurology, Hospital de Santa Maria, Lisbon, Portugal.
authors.forename: Rita
authors.initials: R
authors.lastname: Peralta
authors.affiliation: Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Microbiology, University of Colorado School of Medicine, Aurora, CO, USA. Electronic address: don.gilden@ucdenver.edu.
authors.forename: Don
authors.initials: D
authors.lastname: Gilden
mesh_terms: D000368:Aged; D020804:Encephalitis, Varicella Zoster / Q000150:complications*; D013700:Giant Cell Arteritis / Q000150:complications*; D014645:Herpesvirus 3, Human / Q000472:pathogenicity; D006801:Humans; D008297:Male; D018917:Optic Neuropathy, Ischemic / Q000150:complications*; D013699:Temporal Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D018608:Ultrasonography, Doppler
keywords: Encephalitis; Giant cell arteritis; Ischemic optic neuropathy; Varicella zoster virus; Zoster