Varicella zoster virus (VZV)-mediated vasculitis is a rare cause of stroke, but should be considered in HIV patients where vasculitis can occur in association with central nervous system – immune reconstitution inflammatory syndrome (CNS-IRIS). A literature search revealed 7 reports of VZV vasculitis over the years with no unifying management strategy, highlighting the difficulty in managing rare conditions in the absence of clear guidelines. This is the first documented case of VZV-mediated vasculitis presenting as stroke in the United Kingdom. Our patient made a full recovery with multidisciplinary input from HIV, neurology and radiology specialists.
PicardOBrunereauLPelosseB. Cerebral infarction associated with vasculitis due to varicella zoster virus in patients infected with the human immunodeficiency virus. Biomed Pharmacother1997; 51: 449–454.
2.
NewsomeSDNathA. Varicella-zoster virus vasculopathy and central nervous system immune reconstitution inflammatory syndrome with human immunodeficiency virus infection treated with steroids. J NeuroVirol2009; 15: 288–291.
3.
ZaffiriLVermaRStruzzierriK. Immune reconstitution inflammatory syndrome involving the central nervous system in a patient with HIV infection: a case report and review of literature. New Microbiol2013; 36: 89–92.
4.
OrtizGAKochSFortezaA. Ramsay Hunt Syndrome followed by multifocal vasculopathy and posterior circulation strokes. Neurology2008; 70: 1049–1051.
5.
GutierrezJOrtizG. HIV/AIDS patients with HIV vasculopathy and VZV vasculitis. A case series. Clinical Neuroradiol2011; 21: 145–151.
6.
NagelMACohrsRJMahalingamR. The varicella zoster virus vasculopathies: clinical, CSF, imaging and virological features. Neurology2008; 70: 853–860.
7.
Post MJD, Thurnher MM, Clifford DB, et al. CNS-immune reconstitution inflammatory syndrome in the setting of HIV infection, Part 2: discussion of neuro-immune reconstitution inflammatory syndrome with and without other pathogens. AJNR Am J Neuroradiol, http://www.ajnr.org/content/early/2012/07/12/ajnr.A3184 (2012, accessed 18 May 2013).
8.
PetitoCKChoESLemannW. Neuropathology of acquired immunodeficiency syndrome (AIDS): an autopsy review. J Neuropathol Exp Neurol1986; 45: 635–646.
9.
NagelMAMahalingamRCohrsRJ. Virus vasculopathy and stroke: an under recognised cause and treatment target. Infect Disord Drug Targets2010; 10: 105–111.
10.
British HIV Association and British Infection Association Guidelines for the treatment of Opportunistic Infection in HIV-seropositive individuals 2011. HIV Med 2011;12:61–63.
