acyclovir and Vasculitis

Varicella zoster virus (VZV) ocular infection can manifest purely as a vasculopathy that leads to retinal arteriole occlusion, without any retinitis or vasculitis. This review summarizes our current knowledge of such VZV ocular infection phenotype, incorporating initial descriptions from 1988. We describe the pathogenesis and VZV's manifestations in the retina using fundus photography, fundus fluorescein angiography, optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Laboratory investigations, diagnostic procedures, prognoses, and treatment options are also being reviewed.. Ten case reports where VZV retinal vasculopathy was the primary feature observed after varicella or zoster rash are described. The retinal arteriole, cilioretinal artery, branches of retinal artery, central retinal artery and ophthalmic artery were found to be areas of more rarely affected, neither in the form of vasculitis nor retinitis. Diagnosis is typically made from positive polymerase chain reaction (PCR) for VZV from extracted intraocular fluid or positive serum or cerebrospinal fluid (CSF) anti-VZV immunoglobulin G antibody in the context of compatible ocular findings. In addition, retinal vasculopathy occurring in the setting of confirmed varicella or zoster rashes could be considered potentially pathognomonic. Pathological concepts, including direct VZV infection of affected tissue, persistent inflammation, and/or virus-induced hypercoagulability are also discussed.. VZV may produce a wide spectrum of ocular manifestations with isolated VZV retinal vasculopathy being a rarer presentation. A prompt diagnosis followed by an early treatment of systemic acyclovir with or without corticosteroids is the mainstay of treatment.

Topics: Acyclovir; Chickenpox; Eye Infections; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunoglobulin G; Retinitis; Vasculitis

Vasculitis associated with sarcoid granulomas is an uncommon phenomenon. A 72-year-old female presented with an expanding region of circumscribed alopecia and scalp atrophy of 2 months duration. Biopsy showed non-caseating granulomas, dermal thinning, loss of follicles, fibrosis and muscular vessels disrupted by mixed lymphocyte, macrophage and giant-cell infiltrates. Affected vessels had loss and fragmentation of the elastic lamina, fibrous replacement of their walls and luminal stenosis (endarteritis obliterans). Dermal and vascular advential intralymphatic granulomas and lymphangiectases were found by D2-40 expression, suggesting lymphatic obstruction and poor antigen clearance. No evidence of a post-zoster eruption, systemic sarcoidosis or systemic giant-cell arteritis was found. Two years later, prednisone had halted - but not reversed - progression of her alopecia. Review of the literature showed two types of vasculitis associated with sarcoid granulomas: (i) acute, self-limited leukocytoclastic vasculitis and (ii) chronic granulomatous vasculitis (GV). Persistence of non-degradable material or antigen contributes to the pathogenesis of granulomatous inflammation. In this case, lymphatic obstruction probably impeded clearance of nonimmunologic and/or immunologic stimuli permitting and sustaining the development of sarcoid granulomas and sarcoid GV, ultimately causing scarring alopecia and cutaneous atrophy.

Topics: Acyclovir; Adult; Aged; Alopecia Areata; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Biopsy; Cytokines; Female; Glucocorticoids; Granuloma; Humans; Lymphocytes; Male; Middle Aged; Prednisone; Sarcoidosis; Scalp; Skin Diseases; Valacyclovir; Valine; Vasculitis; Vasculitis, Central Nervous System

There is firm evidence that several viruses can cause systemic vasculitis. Vasculitis induced by antiviral vaccines and drugs is less common and less well know. Most cases consist in de novo vasculitis that resolves spontaneously or under steroid therapy. Thus, the outcome is usually favorable. If an antiviral drug is the cause, it should not be used again in the patient. Another common sense measure is to refrain from immunizing patients with active vasculitis. A recent history of antiviral immunization or antiviral drug treatment should be sought routinely as part of the etiologic work-up of every patient with vasculitis.

Topics: Acyclovir; Antiviral Agents; Didanosine; Hepatitis B Vaccines; Humans; Interferons; Vasculitis; Viral Vaccines; Zidovudine

The Varicella zoster virus may affect the central nervous system (CNS) as a complication of herpes zoster (HZ). A series of neurological syndromes are described and, on the basis of a review of the literature and two illustrative case histories, the symptomatology, pathogenesis, therapeutic possibilities and the diagnostic difficulties in HZ-associated cerebral vasculitis and HZ-associated encephalitis are reviewed. Progressive multifocal encephalopathy in immune-insufficient individuals is briefly mentioned. The diagnosis is most frequently established on the basis of the clinical picture when the characteristic symptoms develop in connection with cutaneous HZ. A long latent period may result in defective recognition of the connection. Immuno-suppression and dissemination are critical determinants for the course of the condition but, in immune-competent individuals, the morbidity and mortality are low. Treatment with acyclovir is employed to an increasing extent with good results but the conditions are rare and clinically controlled investigations are not available. It is important that the possibility of HZ-associated CNS-disease is borne in mind, in view of the therapeutic possibilities. The pathogeneses of these complications is little understood but there is increasing evidence that a direct viral invasion is the mechanism responsible. A post-infectious immune-mediate mechanism is also another popular opinion.

Topics: Acyclovir; Adult; Diagnosis, Differential; Encephalitis; Encephalomyelitis; Female; Herpes Zoster; Humans; Male; Middle Aged; Prognosis; Vasculitis

Herpes zoster ophthalmicus can be complicated by a delayed ipsilateral cerebral angiitis which may cause infarction and a smoldering meningoencephalitis. We describe such a case treated successfully with steroids and acyclovir. It is important to consider the diagnosis of this disorder early since therapeutic intervention may prevent an otherwise high morbidity and mortality. Steroids may have to be continued for some time after clinical resolution, using the ESR as a guideline for decreasing dosages.

Topics: Acyclovir; Aged; Cerebral Infarction; Female; Herpes Zoster Ophthalmicus; Humans; Meningoencephalitis; Prednisone; Vasculitis

A 78-year-old woman was diagnosed with herpes zoster in the first branch of the trigeminal nerve and was treated with amenamevir. Subsequently, she was hospitalized for postherpetic neuralgia. Fever and unconsciousness were observed, and a diagnosis of varicella-zoster virus meningoencephalitis and vasculitis was made. In addition to the antithrombotic therapy, she was treated with intravenous acyclovir and steroid pulse therapy; however, her unconsciousness persisted. Amenamevir was not transferrable to the spinal fluid and resulted in an incomplete treatment of herpes zoster in the cerebral nerve region, suggesting that this case may be related to the severe course of the disease.

Topics: Acyclovir; Aged; Antiviral Agents; Female; Herpes Zoster; Humans; Infusions, Intravenous; Magnetic Resonance Imaging; Meningoencephalitis; Methylprednisolone; Oxadiazoles; Pulse Therapy, Drug; Severity of Illness Index; Trigeminal Nerve; Vasculitis

Herpes simplex virus 2 (HSV-2) is a very rare cause of central nervous system (CNS) infections. We report a case of a young woman with a left middle cerebral artery (MCA) ischemic stroke. The patient had history of HIV-1 infection, with periods of therapeutic non-compliance. Initial computed tomography (CT) imaging studies showed stenosis of the M1 segment of the left MCA, and magnetic resonance imaging (MRI) confirmed infarction of the MCA territory. Serial transcranial Doppler ultrasound revealed progressive occlusion of the MCA and stenosis of the left anterior cerebral artery. Systemic investigation for other causes of stroke was normal. Lumbar puncture revealed a mildly inflammatory cerebrospinal fluid, and HSV-2 DNA was identified by PCR, with a positive viral load in favor of active replication. No other viral or microbiological infections were identified. MRI angiography confirmed a vasculitic process involving the left carotid artery, and a HSV-2 vasculitis diagnosis was assumed. The patient started acyclovir with improvement of clinical features and imaging abnormalities. In the HIV-infected patient, stroke is a multifactorial common cause of morbidity. The physician should take into account a broad differential diagnosis including rare causes and atypical presentations of common etiologies, including HSV-1 and HSV-2 CNS infection.

Topics: Acyclovir; Antiretroviral Therapy, Highly Active; Antiviral Agents; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; Female; Herpes Simplex; Herpesvirus 2, Human; HIV Infections; Humans; Immunocompromised Host; Infarction, Middle Cerebral Artery; Ischemic Stroke; Magnetic Resonance Angiography; Patient Compliance; Vasculitis; Viral Load; Young Adult

Herpes simplex virus type 2 (HSV-2) meningitis dogmatically is benign and self-limited in the immune competent patient. However, we describe how left untreated HSV-2 meningitis can be complicated by vasculitis and both ischemic and hemorrhagic stroke. We report a 57-year-old woman with lymphocytic meningitis complicated by ischemic stroke and intracerebral hemorrhage in the setting of vasculopathy and HSV-2 DNA detected in CSF successfully treated with acyclovir and corticosteroids. Subsequent angiographic magnetic resonance imaging revealed improvement in the vasculopathy after treatment. This case demonstrates that HSV-2 meningitis may take a less benign course and further provides the first evidence of angiographic improvement in addition to clinical improvement after definitive treatment.

Topics: Acyclovir; Adrenal Cortex Hormones; Antiviral Agents; Female; Herpes Simplex; Herpesvirus 2, Human; Humans; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Meningitis, Viral; Middle Aged; Stroke; Vasculitis

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Female; Herpes Simplex; Humans; Lupus Erythematosus, Systemic; Skin; Treatment Outcome; Valacyclovir; Valine; Vasculitis

Intracranial aneurysms in the pediatric population are relatively rare entities. Immunocompromised patients (often from HIV/AIDS or pharmacological immunosuppression) represent a significant fraction of children with cerebral aneurysms. One proposed mechanism of aneurysm formation in these patients is from direct infection of the affected arteries. In this study, the authors report on a case of a 14-year-old girl with common variable immunodeficiency with T-cell dysfunction and a CSF polymerase chain reaction test positive for varicella-zoster virus who underwent evaluation for carotid and basilar artery fusiform aneurysms.

Topics: Acyclovir; Adolescent; Aneurysm; Angiography, Digital Subtraction; Antiviral Agents; Aspirin; Basilar Artery; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Common Variable Immunodeficiency; Female; Herpes Zoster; Humans; Image Processing, Computer-Assisted; Intracranial Aneurysm; Magnetic Resonance Angiography; Platelet Aggregation Inhibitors; T-Lymphocytes; Tomography, X-Ray Computed; Valacyclovir; Valine; Vasculitis; Vertebral Artery

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Humans; Mononeuropathies; Muscular Atrophy; Paresthesia; Peripheral Nerves; Tibial Neuropathy; Ulnar Neuropathies; Valacyclovir; Valine; Vasculitis; Wallerian Degeneration

To report retinal vasculitis in a young, immunocompetent Asian female adult with chickenpox.. Interventional case report. A 32-year-old woman had chickenpox 2 weeks before blurred vision in the left eye. The visual acuity was 20/20 for the right eye and 30/50 for the left eye. The left eye presented keratic precipitates, moderate (2+) cells in the anterior chamber and numerous cells (3+) in the vitreous. The disk was normal. Perivenous exudation was noted mainly in the inferior retina. The sheathed retinal vessels showed late staining but no remarkable leakage on fluorescein angiography. The right eye was normal.. After treatment with acyclovir for 10 days, the visual acuity in the left eye improved to 20/20, and the vasculitis resolved.. Retinal vasculitis may present as a complication of primary varicella infection in an immunocompetent adult.

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Chickenpox; Female; Fluorescein Angiography; Herpesvirus 3, Human; Humans; Immunocompetence; Retinal Diseases; Retinal Vessels; Vasculitis; Visual Acuity

Topics: Acyclovir; Adult; Antibodies, Viral; Antiviral Agents; Aqueous Humor; DNA, Viral; Drug Therapy, Combination; Fluorescein Angiography; Fundus Oculi; Glucocorticoids; Herpes Genitalis; Herpesvirus 2, Human; Humans; Male; Polymerase Chain Reaction; Retinal Diseases; Retinal Vessels; Vasculitis; Visual Acuity

Topics: Acyclovir; Adult; Brain Ischemia; Central Nervous System; Diagnosis, Differential; Herpes Zoster; Herpesvirus 3, Human; Humans; Magnetic Resonance Imaging; Male; Vasculitis

To describe a case of retinal perivasculitis in an immunocompetent patient with systemic herpes simplex infection.. Polymerase chain reaction amplifications were performed for aqueous and blood samples using primers specific for the following members of the herpesvirus family: cytomegalovirus, Epstein-Barr virus, herpes simplex virus (types 1 and 2), and varicella-zoster virus. The patient was placed on intravenous acyclovir and systemic corticosteroids.. A positive polymerase chain reaction signal was found only for herpes simplex virus type 1. Vision in the left eye improved from light perception to 20/25, and signs of retinal perivasculitis resolved.. The use of molecular diagnostic modalities in clinical practice may aid in determining infectious etiologies in patients with atypical clinical manifestations.

Topics: Acyclovir; Antiviral Agents; Aqueous Humor; DNA, Viral; Eye Infections, Viral; Female; Fluorescein Angiography; Fundus Oculi; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunocompetence; Middle Aged; Polymerase Chain Reaction; Retinal Vein; Retinitis; Vasculitis; Viremia

Topics: Acyclovir; Adult; AIDS-Related Opportunistic Infections; Cerebrovascular Disorders; Female; Herpes Zoster; Humans; Male; Middle Aged; Necrosis; Retinitis; Vasculitis

Acute retinal necrosis syndrome in a healthy 32-year-old man was treated successfully with systemic acyclovir and corticosteroids in combination with vitrectomy, 360 degrees encircling band and transscleral cryocoagulation. Herpes simplex virus antibodies were detected in the vitrectomy aspirate supporting the current view that acute retinal necrosis is caused by viruses of the herpes group.

Topics: Acute Disease; Acyclovir; Adult; Humans; Male; Necrosis; Retinitis; Syndrome; Vasculitis; Vitrectomy

The syndrome of granulomatous angiitis related to varicella zoster virus infection often manifests as herpes zoster ophthalmicus followed by contralateral hemiplegia. Forty-five cases have been reported to date, and the authors' experience with two additional cases seen in a one-year period is described. Given the frequency of both stroke and herpes zoster ophthalmicus in an aging population, the authors postulate that granulomatous angiitis is underdiagnosed. There is need for increased awareness of this disease by the non-neurologist. Diagnostic and therapeutic considerations are reviewed.

Topics: Acyclovir; Adult; Aged; Angiography; Aphasia; Cerebrovascular Disorders; Diagnostic Errors; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Steroids; Syndrome; Vasculitis

It has been postulated that Behçet's disease may be a viral induced vasculitis. In the present study plasma exchanges were applied in an attempt to remove circulating immune complexes and restore cellular immunity. High doses of acyclovir were administered in association with plasma exchanges since it has been shown that herpes simplex virus type 1 might be involved in Behçet's vasculitis. Seven patients with severe ocular manifestations of Behçet's disease were selected for the study. Plasma exchanges were carried out at the rate of 3 per week during 3 weeks and then once every two weeks during 3 months followed by 1 per month during 3 months. 45 mg/day/kg acyclovir were administered intravenously for 21 days. At the end of the follow-up period comparative analysis of panretinal fluorescein angiographies before and after treatment showed no change of the fundus lesions in 3 patients, improvement in only 2 patients and significant worsening in 2 patients. The rather negative results of the present trial lead to assume that HSV-1 is not the virus involved, if any, in Behçet's disease. On the other hand, in the present study, the efficiency of plasma exchanges was transient.

Topics: Acyclovir; Adult; Antigen-Antibody Complex; Behcet Syndrome; Combined Modality Therapy; Female; Fluorescein Angiography; Humans; Male; Middle Aged; Plasma Exchange; Prospective Studies; Vasculitis; Virus Diseases; Visual Acuity

Four patients with herpes zoster ophthalmicus and delayed contralateral hemiparesis are described, and their findings are compared with those in patients previously reported in the English language literature. The current patients evidenced multifocal ipsilateral cerebral angiitis by angiography and multifocal infarcts in the distribution of the ipsilateral middle cerebral artery by computed tomographic scanning. Cerebrospinal fluid showed mononuclear pleocytosis, positive oligoclonal bands, and an elevated immunoglobulin G index. Two patients were treated with corticosteroids and acyclovir, and 1 with corticosteroids alone, all without apparent response. Necrotizing angiitis ipsilateral to the herpes zoster ophthalmicus was demonstrated postmortem in 1 patient with multifocal cerebral infarction and progressive leukoencephalopathy. Neither herpes varicella zoster immunocytochemical reactivity nor viral inclusions were seen. The leukoencephalopathy associated with herpes varicella zoster either may be caused by cerebral angiitis or, as previously reported, may be a temporally remote manifestation of persistent herpes varicella zoster infection. The cerebral angiitis associated with herpes varicella zoster is histologically similar to granulomatous angiitis, and both may be related to herpes varicella zoster infection of the cerebral vasculature.

Topics: Acyclovir; Aged; Brain; Cerebral Arterial Diseases; Cerebral Infarction; Dexamethasone; Dominance, Cerebral; Electroencephalography; Female; Hemiplegia; Herpes Zoster Ophthalmicus; Humans; Male; Middle Aged; Prednisone; Tomography, X-Ray Computed; Vasculitis

Topics: Acyclovir; Chickenpox; Child; Guanine; Herpes Zoster; Humans; Immunization, Passive; Immunosuppression Therapy; Leukemia, Lymphoid; Male; Vasculitis