V aricella-zoster virus (VZV) is a common, neurotropic DNA alphaherpesvirus that causes varicella (chickenpox) upon primary infection, after which virus becomes latent in ganglionic neurons along the entire neuraxis (1-6). With a decline in VZVspecific cell-mediated immunity, VZV reactivates in elderly or immunocompromised individuals, most commonly causing zoster (shingles). VZV can also reactivate and spread transaxonally to cerebral arteries to produce stroke with or without rash (VZV vasculopathy). Recent studies show that aside from stroke, VZV vasculopathy presents as giant cell arteritis, which is the most common cause of systemic vasculitis in the elderly (7), as well as granulomatous aortitis (8).Studies of VZV-infected cerebral and temporal arteries from patients with VZV vasculopathy show viral antigen predominantly in the outermost adventitia in early infection, supporting deposition of virus from nerve fibers that terminate within this layer followed by transmural spread (7, 9). Persistent inflammation with a predominance of T cells and macrophages can be seen even up to 10 months after disease onset and is associated with pathological vascular remodeling (10). The mechanism(s) by which inflammatory cells persist to cause vascular damage in VZV-infected arteries is unknown.Programmed cell death ligand 1 (PD-L1), a 40-kDa type 1 transmembrane protein in the B7 immunoglobulin family that can be expressed on virtually all nucleated cells (11), suppresses the immune system through interaction with its receptor, pro-