Patient selection: Varicella zoster, primary or reactivation
Pathogenesis: invasion of endothelial cells with inflammation, causing thickening of the intima and vascular remodeling.
The risk is greater in immunocompromised patients but also may occur in the immunocompetent.
Vascular involvement may include:
(1) obliterative angiitis
(2) giant cell arteritis
(3) capillaritis
(4) small vessel vasculitis
Manifestations may include:
(1) cutaneous vasculitis
(2) end-organ ischemia or infarction
(3) renal failure
(4) retinal vasculopathy
(5) possibly temporal arteritis
(6) neuropathy
Often the patient also has evidence of intracerebral involvement.
The vasculitis may be present even in the absence of a vesicular rash.
