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Gastrointestinal symptomatology as a complication of herpes zoster (HZ) is extremely rare, with the majority of reported cases showing only temporal or radiological evidence of GI tract involvement by varicella zoster virus (VZV) infection. We present the first case of documented direct VZV infection in the muscularis propria of the gut presenting as intestinal pseudo-obstruction (Ogilvie's syndrome). The patient was a 34-yr-old HIV+ man who developed small bowel pseudo-obstruction in association with disseminated cutaneous HZ. A partial ileocolectomy specimen demonstrated a focal ulcer in the terminal ileum. Immunohistochemistry against VZV gpI demonstrated diffuse staining of the muscularis propria and myenteric plexi throughout the length of the specimen. Viral particles consistent with Herpesviridae were shown to be present ultrastructurally. We postulate that the viral infection in the neuronal plexi and muscularis propria caused muscle injury leading to pseudo-obstruction.

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We describe a case in which fludeoxyglucose F 18 positron emission tomography (PET) led directly to the diagnosis of giant cell arteritis in an elderly woman with a fever of unknown origin. The patient presented with a 3-month history of fatigue, fever, headache, visual disturbance, jaw claudication, and anemia. A computed tomographic scan showed an anterior mediastinal mass that was suspected of being malignant. A fludeoxyglucose F 18 PET scan performed for preoperative evaluation identified striking uptake of fludeoxyglucose F 18 in the walls of the entire aorta, left main coronary artery, and subclavian, carotid, and common iliac arteries bilaterally, suggestive of an arteritis, a diagnosis subsequently confirmed by the findings of an arterial biopsy. Her erythrocyte sedimentation rate was 129 mm/h. There was normalizaton of the PET scan 2 weeks following treatment with prednisolone. This case suggests that fludeoxyglucose F 18 PET contributes to the noninvasive diagnosis of giant cell arteritis, as well as to the evaluation of the extent of disease, response to therapy, and disease recurrence.

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