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2016 ; 29
(3
): 275-9
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Varicella zoster virus and giant cell arteritis
#MMPMID26871403
Gilden D
; Nagel MA
Curr Opin Infect Dis
2016[Jun]; 29
(3
): 275-9
PMID26871403
show ga
PURPOSE OF REVIEW: Giant cell arteritis (GCA) is a serious disease and the most
common cause of vasculitis in the elderly. Here, studies describing the recent
discovery of varicella zoster virus (VZV) in the temporal arteries of patients
with GCA are reviewed. RECENT FINDINGS: GCA is characterized by severe
headache/head pain and scalp tenderness. Many patients also have a history of
vision loss, jaw claudication, polymyalgia rheumatica, fever, night sweats,
weight loss, and fatigue. The erythrocyte sedimentation rate and C-reactive
protein are usually elevated. Diagnosis is confirmed by temporal artery biopsy,
which reveals vessel wall damage and inflammation, with multinucleated giant
cells and/or epithelioid macrophages. Skip lesions are common. Importantly,
temporal artery biopsies are pathologically negative in many clinically suspect
cases. The present review highlights recent virological findings in temporal
arteries from patients with pathologically verified GCA and in temporal arteries
from patients who manifest clinical and laboratory features of GCA but whose
temporal artery biopsies are pathologically negative for GCA. Virological
analysis revealed that VZV is present in most GCA-positive and GCA-negative
temporal artery biopsies, particularly in skip areas that correlate with adjacent
GCA disease. SUMMARY: The presence of VZV in GCA-positive and GCA-negative
temporal arteries reflects the possible role of VZV in triggering the
immunopathology of GCA and indicates that both groups of patients should be
treated with antivirals in addition to corticosteroids. Whether oral antiviral
agents and steroids are as effective as intravenous acyclovir and steroids, and
the dosage and duration of treatment, remain to be determined.