Carotico-cavernous fistula secondary to Varicella zoster?

We describe the case of a previously well, 73-year-old male patient who presented with a spontaneous high flow, carotico-cavernous fistula, 1 month following an attack of herpes zoster. We postulate that the zoster virus was the underlying cause, given the history and time frame between the preceding shingles and the subsequent development of the fistula. The literature supporting this hypothesis is reviewed.