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Case Reports
. 2024 May 31;16(5):e61419.
doi: 10.7759/cureus.61419. eCollection 2024 May.

Varicella Zoster Virus Vasculopathy: An Under-Recognized Entity

Anil M Philip  1 , Lina J George  2 , Anas N  3 , Jemimah Nayar  4
Affiliations
Case Reports

Varicella Zoster Virus Vasculopathy: An Under-Recognized Entity

Anil M Philip et al. Cureus. .

Abstract

Varicella zoster virus (VZV) vasculopathy is a rare yet potentially severe neurological manifestation resulting from VZV reactivation, primarily affecting immunocompromised individuals. We present a case report of a 61-year-old male with VZV vasculopathy who initially presented with herpes zoster ophthalmicus, subsequently complicated by meningoencephalitis and an acute infarct in the territory of the left middle cerebral artery (MCA). Imaging revealed acute and chronic infarcts in the capsuloganglionic regions, accompanied by thickening and enhancement of the left MCA wall. Treatment involved a 14-day course of intravenous acyclovir, supplemented with oral prednisolone, resulting in modest clinical improvement. VZV vasculopathy represents an infrequently acknowledged neurological syndrome, particularly prevalent among immunocompromised individuals. Early recognition and appropriate intervention offer promise in ameliorating outcomes for affected patients. This case emphasizes the importance of including VZV vasculopathy in the differential diagnosis of neurological deficits, especially within high-risk populations.

Keywords: cerebrovascular accident (stroke); herpes zoster ophthalmicus; varicella zoster vasculopathy; varicella-zoster virus; vzv encephalitis.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. MRI of the Orbit and Brain With Angiography
(A) T2 FLAIR image showing hyperintensity in the left thalamus and capsuloganglionic region (red arrows). (B) T2-weighted image showing hyperintensity in the left thalamus and capsuloganglionic region (red arrows). (C) T2-weighted image showing subtle hyperintensity in the left cerebellar peduncle of the midbrain (red arrow). (D) T1-weighted post-gadolinium axial image showing thickening and enhancement of the walls of the bilateral middle cerebral arteries (red arrows). (E) T2-weighted coronal image showing bulky left lateral rectus muscle (red arrow). (F) T1 post-gadolinium sagittal image showing abnormal prepontine leptomeningeal enhancement (red arrow).
See this image and copyright information in PMC

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