Fatal giant cell myocarditis associated with shingles of the left upper chest

Varicella Zoster Virus (VZV), following an initial chicken pox infection earlier in life, can occasionally reactivate in dorsal nerve root ganglia to cause shingles, classically diagnosed by a vesicular skin eruption/rash in a single dermatome. We report a sudden death of an elderly woman with shingles of the left upper chest and axilla. A post mortem examination identified the cause of death as giant cell myocarditis, and VZV was identified in myocardial tissue. This is the first example in the literature of shingles associated with histologically-proven giant cell myocarditis and fatality in an otherwise immunocompetent patient. This case highlights an unexpected finding only identified using post mortem histology. It also adds to the body of evidence suggesting that VZV could potentially reactivate in both autonomic and sensory ganglia at the same time during episodes of shingles.