Subarachnoid hemorrhage and granulomatous angiitis of the basilar artery: demonstration of the varicella-zoster-virus in the basilar artery lesions

Abstract

A 70-year-old man, with regional herpes zoster (C2) of 10 weeks duration, died following subarachnoid hemorrhage caused by the rupture of an aneurysm in the basilar artery. Granulomatous angiitis, with multinucleated giant cells, was found at autopsy in the wall of the aneurysm. Electron microscopy of the basilar artery disclosed intracytoplasmic viral particles with an envelope which measured 150-220 nm in diameter. Immunohistochemistry studies revealed varicella-zoster-virus-related antigen in the cytoplasm and/or in the nucleus of histiocytes in the vessel wall. These findings suggest that varicella-zoster virus may be linked to the development of granulomatous angiitis.