Abdominal pain in varicella: an unusual cause of spontaneous splenic rupture

Vial, Irshaad; Hamidou, M.; Coste-Burel, M.; Baron, D.

doi:10.1097/01.mej.0000104026.33339.d5

Cited by 5 publications

(4 citation statements)

References 5 publications

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“…The case we present is consistent with these reports, with abdominal pain, likely representing splenic rupture itself, preceding the rash by 48 h. Haemodynamic instability was not present, as with four of the five published reports. Splenomegaly was present as would be expected with a spontaneous splenic rupture, although there is one case in the literature which reported splenic rupture of a normal sized spleen [ 12 ]. There was no history of even minimal trauma, as with previous reports.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous splenic rupture complicating primary varicella zoster infection: a case report

Uthayakumar

Harrington

2018

BMC Res Notes

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BackgroundPrimary varicella zoster virus (VZV) infection is a common illness, predominantly affecting children. Its course is typically benign, although severe complications have been described. Splenic rupture is an extremely rare and potentially fatal complication of primary VZV infection, with only a handful of cases reported in the literature.Case PresentationA 32-year-old Romanian man with no significant past medical history, presented with a 2 day history of sudden onset, worsening generalised abdominal pain and a 1 day history of vomiting. The following day he developed fevers and a generalised widespread erythematous rash consisting of clusters of macules, papules and vesicles at different stages of development. There was no history of sore throat, coryza, arthralgia, myalgia, cough, shortness of breath, weight loss, or night sweats. There was no recent illness and no history of trauma. CT abdomen showed splenic rupture with intra-abdominal haemorrhage. Admission bloods showed anaemia and thrombocytopenia, with haemoglobin 110 g/l and platelets 78 × 109/l. Viral PCR of vesicle fluid from the rash was positive for VZV DNA confirming the clinical diagnosis of primary varicella zoster infection. Viral serology also confirmed recent infection. He was haemodynamically resuscitated, and underwent laparotomy and splenectomy. He was commenced on IV acyclovir and completed a 5 day course. Prior to discharge he was commenced on recommended splenectomy secondary prevention treatment.ConclusionThere are several reported complications of varicella infection, more commonly in the immunocompromised population. Spontaneous splenic rupture is an unusual complication of primary VZV infection. Here we report the sixth known case in the literature. Splenic rupture should be considered in cases of primary varicella in young adults presenting with abdominal pain.

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Section: Discussionmentioning

confidence: 99%

Spontaneous splenic rupture complicating primary varicella zoster infection: a case report

Uthayakumar

Harrington

2018

BMC Res Notes

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“…This case has demonstrated a rare occurrence of atraumatic splenic rupture secondary to VZV. In 2012 a systematic review of 613 cases of splenic rupture from 1950 to 2011 identified 143 infection associated ruptures [ 9 ], only one of these was varicella related [ 10 ]. The most common infections presented by this review were malaria (65 reports) and EBV (42 reports).…”

Section: Discussionmentioning

confidence: 99%

Open splenectomy for Varicella zoster induced spontaneous splenic rupture

Sykes

Azhar

John

et al. 2018

International Journal of Surgery Case Reports

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“…Harris and Boland5 confirmed the diagnosis by positive viral serology for VZV IgM and IgG, and splenic histological sections, demonstrating reactive follicular hyperplasia and infiltration of lymphocytes, as with our case (figures 2 and 3). Vial et al 6 diagnosed splenic rupture at laparoscopy, with subcapsular haematoma without active bleeding. In this case, the patient did not undergo splenectomy, so histology was unavailable.…”

Section: Discussionmentioning

confidence: 99%

“…Some reports suggest that non-operative management may be appropriate in selected cases if the patient remains haemodynamically stable 6 7. However, non-operative management may leave the patient at increased risk of further haemorrhage and progressive splenomegaly.…”

Section: Discussionmentioning

confidence: 99%

Varicella zoster virus infection is an unusual cause of splenic rupture

et al. 2015

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A 22-year-old man presented with a 1-day history of severe abdominal pain. He developed a generalised vesicular rash 12 h prior to admission. On examination, he was maximally tender with peritonism in the lower abdomen. Working diagnosis was perforated appendix and a decision to investigate with CT was made, which showed intra-abdominal haemorrhage likely arising from a ruptured spleen. After a period of observation, he subsequently underwent laparotomy and emergency splenectomy. Viral PCR from vesicular fluid was positive for varicella zoster virus. Viral serology was otherwise negative.

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Abdominal pain in varicella: an unusual cause of spontaneous splenic rupture

Cited by 5 publications

References 5 publications

Spontaneous splenic rupture complicating primary varicella zoster infection: a case report

Spontaneous splenic rupture complicating primary varicella zoster infection: a case report

Open splenectomy for Varicella zoster induced spontaneous splenic rupture

Varicella zoster virus infection is an unusual cause of splenic rupture

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