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Am J Ophthalmol. 2018 Mar;187:51-60. doi: 10.1016/j.ajo.2017.12.017. Epub 2017 Dec 30.

Identification of Herpes Zoster-Associated Temporal Arteritis Among Cases of Giant Cell Arteritis.

Author information

1
Division of Infectious Diseases/Virology Laboratory, Children's Hospital, University of Iowa, Iowa City, Iowa.
2
F. C. Blodi Eye Pathology Laboratory, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa.
3
Division of Infectious Diseases/Virology Laboratory, Children's Hospital, University of Iowa, Iowa City, Iowa. Electronic address: Charles-grose@uiowa.edu.
4
Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri.
5
Division of Neuro-Ophthalmology, Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa.

Abstract

PURPOSE:

To examine whether herpes zoster antigen (also called varicella-zoster virus antigen) was detectable in temporal artery biopsies taken from individuals with giant cell arteritis (GCA).

DESIGN:

Retrospective comparative case series.

METHODS:

Sections of formalin-fixed paraffin-embedded temporal arteries were examined first by hematoxylin-eosin (H&E) staining to establish the diagnosis of GCA. Adjacent sections of the same biopsy were then examined by immunohistochemistry, using 2 different monoclonal antibodies against a major antigen of varicella-zoster virus called gE. Pathologic specimens were obtained from patients cared for at the University of Iowa and Washington University in St. Louis ophthalmology clinics.

RESULTS:

The study included biopsies from 25 patients with symptoms of GCA as well as positive H&E pathology and 25 patients with symptoms compatible with GCA but negative H&E pathology. Among the GCA-positive group, 3 patients had positive staining for herpes zoster antigen. Among the GCA-negative group, herpes zoster antigen was not detected in any biopsy. In both groups of patients, false-positive staining for herpes zoster antigen was detected in the presence of calcifications in the arteries. False-positive staining was also detected on some extra-arterial skeletal muscle and erythrocytes.

CONCLUSION:

Herpes zoster antigen was detected in 3 of 25 temporal arteries from patients with biopsy-proven GCA. One of the 3 positive cases was noteworthy because the patient had had herpes zoster ophthalmicus diagnosed 3 weeks before the onset of GCA symptoms. False-positive staining for herpes zoster antigen was detected on several temporal artery biopsies.

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