Atypical varicella-zoster virus infection in an immunocompromised patient: Result of a virus-induced vasculitis

Varicella-Zoster Virus Vasculitis: A Case of Recurrent Varicella without Epidermal Involvement

“…We interpret the whole clinical manifestations in our patient as recurrent varicella. However, this type of recurrent varicella still differs from previously reported cases [5,[18][19][20][21][22] by several aspects including its seemingly zosteriform distribution, its uneventful outcome and the lack of epidermal involvements. Such a peculiar presentation limited to vascular involvement might be due to viremia with low viral load as it was previously reported in subjects showing no clinical sign of VZV disease [23].…”

“…Purpuric and necrotic vasculitic lesions of the skin have already been reported in VZV lesions [5,21]. One of the characteristics of the present case is the lack of epidermal and neural involvement.…”

“…In the present case, there was no VZV immunoreactivity in nerves suggesting that hematogenous dissemination was the source of infection. A case previously reported in the literature [5] might well correspond to a similar pathomechanism despite the differing opinion expressed by the authors.…”

“…The involvement of dermal dendrocytes can be explained in two ways, namely a viral protein phagocytosis or a true infection of the cells. In facts, VZV is able to infect endothelial cells and to induce a spectrum of vasculopathies ranging from a discrete capillaritis to obliterative angiitis and granulomatous vasculitis [5,[24][25][26]. Most often, the proposed mechanism for VZV spread is a contiguous infection from nerves to the vessels.…”

“…Varicella and herpes zoster are the most common conditions. However, other unusual clinical presentations have been reported, particularly in immunocompromised patients [1][2][3][4][5]. Immunohistochemistry using specific monoclonal antibodies directed to different proteins and glycoproteins expressed sequentially during the VZV replication cycle allows to locate and identify the virus in different cell lines.…”