{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T14:06:23Z","timestamp":1775570783717,"version":"3.50.1"},"reference-count":14,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T00:00:00Z","timestamp":1772755200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Ministry of Health and Welfare, Republic of Korea","award":["RS-2023-KH134657"],"award-info":[{"award-number":["RS-2023-KH134657"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Blood Res."],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Varicella zoster virus (VZV) vasculopathy is a rare but severe neurological complication that frequently results in a reversible cerebral vasoconstriction syndrome (RCVS). Diagnosis is often delayed because early manifestations are nonspecific and radiologic findings often overlap with those of other cerebrovascular disorders. We describe the fatal case of a heavily pretreated 60-year-old man with refractory diffuse large B-cell lymphoma undergoing evaluation for chimeric antigen receptor (CAR) T-cell therapy. The patient developed multifocal intracranial arterial stenosis and an acute infarction during chemotherapy-induced immunosuppression. The initial radiological features suggested RCVS; however, cerebrospinal fluid (CSF) analysis using polymerase chain reaction (PCR) and anti-IgG antibodies confirmed the presence of VZV. Despite intravenous acyclovir and high-dose corticosteroids, the vasculopathy progressed rapidly, resulting in recurrent infarctions, seizures, and death. This case highlights the diagnostic complexity of VZV vasculopathy in immunocompromised patients and underscores the importance of early CSF evaluation, heightened clinical vigilance for opportunistic viral complications, and the potential diagnostic value of vessel wall magnetic resonance imaging (MRI) in differentiating VZV vasculopathy from mimicking conditions such as RCVS.<\/jats:p>","DOI":"10.1007\/s44313-026-00126-5","type":"journal-article","created":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T08:34:48Z","timestamp":1772786088000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Rapidly progressive varicella zoster virus vasculopathy in a chemotherapy- and steroid-immunosuppressed patient with refractory diffuse large B-cell lymphoma: diagnostic and therapeutic challenges"],"prefix":"10.1007","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8089-3800","authenticated-orcid":false,"given":"Kyoung Il","family":"Min","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gi-June","family":"Min","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ki-Seong","family":"Eom","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5429-4839","authenticated-orcid":false,"given":"Seok-Goo","family":"Cho","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,3,6]]},"reference":[{"key":"126_CR1","doi-asserted-by":"publisher","first-page":"112","DOI":"10.1016\/j.jneuroim.2017.03.014","volume":"308","author":"MA Nagel","year":"2017","unstructured":"Nagel MA, Jones D, Wyborny A. Varicella zoster virus vasculopathy: the expanding clinical spectrum and pathogenesis. J Neuroimmunol. 2017;308:112\u20137. https:\/\/doi.org\/10.1016\/j.jneuroim.2017.03.014.","journal-title":"J Neuroimmunol"},{"key":"126_CR2","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1007\/s13311-016-0430-x","volume":"13","author":"PG Kennedy","year":"2016","unstructured":"Kennedy PG. Issues in the treatment of neurological conditions caused by reactivation of varicella zoster virus (VZV). Neurotherapeutics. 2016;13:509\u201313. https:\/\/doi.org\/10.1007\/s13311-016-0430-x.","journal-title":"Neurotherapeutics"},{"key":"126_CR3","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1111\/j.1365-2990.2011.01167.x","volume":"37","author":"D Gilden","year":"2011","unstructured":"Gilden D, Mahalingam R, Nagel MA, Pugazhenthi S, Cohrs RJ. Review: the neurobiology of varicella zoster virus infection. Neuropathol Appl Neurobiol. 2011;37:441\u201363. https:\/\/doi.org\/10.1111\/j.1365-2990.2011.01167.x.","journal-title":"Neuropathol Appl Neurobiol"},{"key":"126_CR4","doi-asserted-by":"publisher","DOI":"10.1177\/2054270416675081","volume":"8","author":"AW Barritt","year":"2017","unstructured":"Barritt AW, Vundavalli S, Hughes PJ. Varicella vasculopathy presenting with thunderclap headache. JRSM Open. 2017;8:2054270416675081. https:\/\/doi.org\/10.1177\/2054270416675081.","journal-title":"JRSM Open"},{"key":"126_CR5","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1007\/s00415-022-11425-z","volume":"270","author":"DK Erhart","year":"2023","unstructured":"Erhart DK, Ludolph AC, Althaus K. RCVS: by clinicians for clinicians-a narrative review. J Neurol. 2023;270:673\u201388. https:\/\/doi.org\/10.1007\/s00415-022-11425-z.","journal-title":"J Neurol"},{"key":"126_CR6","doi-asserted-by":"publisher","DOI":"10.1186\/s12929-022-00857-4","volume":"29","author":"SP Chen","year":"2022","unstructured":"Chen SP, Wang SJ. Pathophysiology of reversible cerebral vasoconstriction syndrome. J Biomed Sci. 2022;29:72. https:\/\/doi.org\/10.1186\/s12929-022-00857-4.","journal-title":"J Biomed Sci"},{"key":"126_CR7","doi-asserted-by":"publisher","DOI":"10.3390\/v17010133","volume":"17","author":"J Sassine","year":"2025","unstructured":"Sassine J, Siegrist EA, Chemaly RF. Herpesvirus infections after chimeric antigen receptor T-cell therapy and bispecific antibodies: a review. Viruses. 2025;17:133. https:\/\/doi.org\/10.3390\/v17010133.","journal-title":"Viruses"},{"key":"126_CR8","doi-asserted-by":"publisher","first-page":"955","DOI":"10.1016\/j.jtct.2024.07.018","volume":"30","author":"Z Shahid","year":"2024","unstructured":"Shahid Z, Jain T, Dioverti V, Pennisi M, Mikkilineni L, Thiruvengadam SK, et al. Best practice considerations by The American Society of Transplant and Cellular Therapy: infection prevention and management after chimeric antigen receptor T cell therapy for hematological malignancies. Transplant Cell Ther. 2024;30:955\u201369. https:\/\/doi.org\/10.1016\/j.jtct.2024.07.018.","journal-title":"Transplant Cell Ther"},{"key":"126_CR9","doi-asserted-by":"publisher","first-page":"343","DOI":"10.3348\/jksr.2013.69.5.343","volume":"69","author":"JS Lee","year":"2013","unstructured":"Lee JS, Kim SH, Jeong SY. Reversible cerebral vasoconstriction syndrome: a case report. J Korean Soc Radiol. 2013;69:343\u20136. https:\/\/doi.org\/10.3348\/jksr.2013.69.5.343.","journal-title":"J Korean Soc Radiol"},{"key":"126_CR10","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.jacc.2017.05.015","volume":"70","author":"M-C Kim","year":"2017","unstructured":"Kim M-C, Yun S-C, Lee H-B, Lee P, Lee S-W, Choi S-H, et al. Herpes zoster increases the risk of stroke and myocardial infarction. J Am Coll Cardiol. 2017;70:295\u20136. https:\/\/doi.org\/10.1016\/j.jacc.2017.05.015.","journal-title":"J Am Coll Cardiol"},{"key":"126_CR11","doi-asserted-by":"publisher","DOI":"10.1186\/s41983-023-00607-9","volume":"59","author":"MZ Ribas","year":"2023","unstructured":"Ribas MZ, Paticci\u00e9 GF, de Meiros SDP, de Oliveira Veras A, Noleto FM, dos Santos JCC. Reversible cerebral vasoconstriction syndrome: literature review. Egypt J Neurol Psychiatr Neurosurg. 2023;59:5. https:\/\/doi.org\/10.1186\/s41983-023-00607-9.","journal-title":"Egypt J Neurol Psychiatr Neurosurg"},{"key":"126_CR12","doi-asserted-by":"publisher","first-page":"898","DOI":"10.1177\/0961203319845485","volume":"28","author":"SW Chung","year":"2019","unstructured":"Chung SW, Lee KM, Heo SH, Ra R, Hong SJ, Yang HI, et al. A systemic lupus erythematosus patient with thunderclap headache: reversible cerebral vasoconstriction syndrome. Lupus. 2019;28:898\u2013902. https:\/\/doi.org\/10.1177\/0961203319845485.","journal-title":"Lupus"},{"key":"126_CR13","doi-asserted-by":"publisher","first-page":"293","DOI":"10.3174\/ajnr.A6378","volume":"41","author":"JM Ospel","year":"2020","unstructured":"Ospel JM, Wright CH, Jung R, Vidal LLM, Manjila S, Singh G, et al. Intra-arterial verapamil treatment in oral therapy-refractory reversible cerebral vasoconstriction syndrome. AJNR Am J Neuroradiol. 2020;41:293\u20139. https:\/\/doi.org\/10.3174\/ajnr.A6378.","journal-title":"AJNR Am J Neuroradiol"},{"key":"126_CR14","doi-asserted-by":"publisher","first-page":"662","DOI":"10.1002\/ajh.27198","volume":"99","author":"H Qian","year":"2024","unstructured":"Qian H, Yang X, Zhang T, Zou P, Zhang Y, Tian W, et al. Improving the safety of CAR-T-cell therapy: the risk and prevention of viral infection for patients with relapsed or refractory B-cell lymphoma undergoing CAR-T-cell therapy. Am J Hematol. 2024;99:662\u201378. https:\/\/doi.org\/10.1002\/ajh.27198.","journal-title":"Am J Hematol"}],"container-title":["Blood Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44313-026-00126-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s44313-026-00126-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s44313-026-00126-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T08:34:49Z","timestamp":1772786089000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s44313-026-00126-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,6]]},"references-count":14,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,12]]}},"alternative-id":["126"],"URL":"https:\/\/doi.org\/10.1007\/s44313-026-00126-5","relation":{},"ISSN":["2287-979X","2288-0011"],"issn-type":[{"value":"2287-979X","type":"print"},{"value":"2288-0011","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,6]]},"assertion":[{"value":"28 December 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 January 2026","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 January 2026","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 March 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This case report was approved by the Institutional Review Board and Ethics Committee of the Catholic Medical Center, Republic of Korea (KC25ZASI0901), and was conducted in accordance with the tenets of the Helsinki Declaration. Written informed consent was obtained from the patient for the publication of this case report and the accompanying images.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"11"}}