A Diagnostic Approach to VZV Vasculopathy Using MR Vessel Wall Imaging

Area of Science:

• Neurology
• Infectious Diseases
• Immunology

Background:

• Systemic lupus erythematosus (SLE) patients on immunosuppressants are vulnerable to opportunistic infections.
• Herpes zoster, caused by varicella-zoster virus (VZV), can lead to neurological complications.
• Cerebral vasculopathy is a rare but serious complication of VZV reactivation.

Purpose of the Study:

• To report a case of VZV vasculopathy presenting as recurrent ischemic stroke.
• To highlight the diagnostic utility of vessel wall imaging (VWI) in VZV vasculopathy.
• To demonstrate the efficacy of antiviral and immunosuppressive therapy in VZV vasculopathy.

Main Methods:

• Case presentation of a 43-year-old woman with SLE and recent herpes zoster.
• Neuroimaging including MRI and VWI to assess cerebral arteries.
• Cerebrospinal fluid analysis for VZV DNA and antibodies.
• Treatment with acyclovir and corticosteroids.

Main Results:

• The patient developed hemiparesis and aphasia following herpes zoster.
• MRI revealed anterior cerebral artery infarction and middle cerebral artery (MCA) stenosis.
• VWI showed MCA wall thickening suggestive of vasculitis.
• CSF analysis confirmed VZV DNA and elevated anti-VZV IgG index.
• Treatment led to VZV DNA clearance.

Conclusions:

• VZV vasculopathy is a significant risk in immunocompromised patients.
• VWI is a valuable tool for diagnosing VZV vasculopathy.
• Prompt treatment with acyclovir and corticosteroids can resolve VZV DNA and prevent further neurological events.