The Interplay Between Varicella-Zoster Virus and Giant Cell Arteritis: An In-Depth Narrative Review

Giant cell arteritis (GCA) is a large-vessel vasculitis that is commonly associated with inflammation of the blood vessels within the head and neck. The condition primarily affects older and immunocompromised individuals and is diagnosed through a combination of physical examination, laboratory tests, and, in some cases, biopsy. Most patients present with headaches, visual disturbances, and jaw claudication accompanied by low-grade fever, fatigue, and weight loss. Varicella-zoster virus (VZV) may play a role in the pathogenesis of GCA. VZV DNA has been identified within the cerebral arteries of a patient with fatal vasculitis of the central nervous system (CNS) without dermatologic presentation. Specifically, they identified VZV DNA within the cerebral arteries of a patient with fatal vasculitis of the CNS without dermatologic presentation, which has been further explored in more recent studies. While the presence of VZV within vascular endothelial cells and within temporal artery biopsies of patients with and without GCA suggests a possible overlap with GCA, debatable findings across recent studies, combined with inconsistent replication of biopsy techniques, have raised questions. The treatment of GCA involves high-dose corticosteroids, but in some cases, antivirals have been used when patients are resistant to corticosteroid treatment or if there is a strong clinical suspicion of VZV involvement. Multiple case reports have demonstrated the effectiveness of antivirals in treating GCA, but their validation remains limited by a lack of randomized controlled trials. In this narrative literature review, we explored current research efforts exploring the relationship between VZV and GCA. This study underscores the need for additional research to gain insight into the role of VZV in the pathophysiology of GCA and to establish evidence-based, more targeted treatment approaches that improve patient outcomes.