Disseminated VZV infection and asymptomatic VZV vasculopathy after steroid abuse

Abstract

A 60-year-old man who abused corticosteroids developed thoracic-distribution zoster. Varicella zoster virus (VZV) DNA was found in non-healing skin 3 months later. He died suddenly 2 months later. Skin was ulcerated and necrotic. VZV was widespread in organs and arteries, particularly coronary arteries and aorta, with VZV vasculopathy in the posterior cerebral artery.

Herpes Zoster in the Older Adult

“…At this time, VZV establishes a latent state in dorsal root ganglia of peripheral neurons, cranial nerve ganglia and autonomic nerve ganglia along the entire neuroaxis through retrograde axonal transport from the cutaneous lesions or by hematogenous spread during the viremic phase. 7, 11 Months to years later, reactivation of VZV manifests clinically as HZ, with the spectrum of disease ranging from disseminated zoster to the more commonly seen typical dermatomal HZ.…”

“…It should be considered in persons with current or recent cutaneous zoster if their clinical or laboratory parameters suggest internal organ involvement and PCR in blood, histologic or culture data supports the presence of VZV. 11, 21–24 …”

“…The presence of VZV in intracerebral and coronary arteries of these patients in post mortem studies provides histological support for this finding. 11, 13, 35, 36 Vasculopathy results from the transaxonal migration of reactivated VZV to the adventia of arteries where infection is established, followed by transmural migration to the media and intima and vascular remodeling. 37 The presence of VZV in the arteries, in conjunction with the increased inflammatory response seen in infected individuals might result in disruption of atherosclerotic plaques.…”

“…7, 38 In some instances, VZV vasculopathy may result in cardiac dysfunction without any concomitant neurological manifestation. 11 …”

Varicella Zoster Virus: A Common Cause of Stroke in Children and Adults

“…Although many GCA patients improve with steroids, reports are legion of GCA patients who relapse with corticosteroid withdrawal and may also develop more disseminated VZV vasculopathy and die (60,61). Because VZV triggers the immunopathology of GCA, antiviral treatment is likely to confer additional benefit to corticosteroids.…”