Fatal Varicella-Zoster Hepatitis Presenting with Severe Abdominal Pain: A Case Report and Review of the Literature

Pishvaian, Aline Charabaty; Bahrain, Michelle; Lewis, James H.

doi:10.1007/s10620-006-8037-4

Cited by 17 publications

(9 citation statements)

References 14 publications

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“…Cases have been reported in which immunocompetent patients have required liver transplantation after VZV-induced acute liver failure and have died because of multiorgan dysfunction after fulminant hepatic failure. [38][39][40] Gastrointestinal complications of varicella are common in immunocompromised patients. Gastrointestinal complications can manifest before the hallmark dermatologic manifestations of varicella, especially in immunocompromised individuals.…”

Section: Simultaneous Occurrence Of Varicellamentioning

confidence: 99%

Simultaneous Occurrence of Varicella Zoster Virus-Induced Pancreatitis and Hepatitis in a Renal Transplant Recipient: A Case Report and Review of Literature

Chhabra

Ranjan

Bhasin

2017

TPJ

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Introduction: Gastrointestinal complications are common after renal transplantation, including oral lesions, esophagitis, gastritis, diarrhea, and colon carcinoma. The differential diagnosis is difficult in this scenario because multiple factors such as drugs, infections, and preexisting gastrointestinal disease come into play.Case Presentation: We report a case of varicella zoster virus-induced pancreatitis and hepatitis in a renal transplant recipient. The patient underwent renal transplantation 3 years earlier and now presented with severe pain in the epigastrium radiating to his back and had raised serum lipase levels and skin lesions characteristic of varicella. Liver enzyme levels were also elevated. He was started on a regimen of acyclovir. His pain improved in 24 hours, and liver enzyme levels returned to normal in 48 hours.Discussion: There is a paucity of literature on the simultaneous occurrence of varicella zoster virus-induced hepatitis and pancreatitis in both immunocompetent and immunocompromised patients. Our case highlights the gastrointestinal complications of varicella infection in immunocompromised patients that may precede the characteristic dermatologic manifestations, and the fact that rarely both hepatitis and pancreatitis may be seen.

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Section: Simultaneous Occurrence Of Varicellamentioning

confidence: 99%

Simultaneous Occurrence of Varicella Zoster Virus-Induced Pancreatitis and Hepatitis in a Renal Transplant Recipient: A Case Report and Review of Literature

Chhabra

Ranjan

Bhasin

2017

TPJ

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Section: Sirsmentioning

confidence: 99%

“…[1][2][3][4][5] We present a case of a patient affected by symptomatic factor V Leiden (FVL) mutation and mosaic trisomy 8 related myelodysplastic syndrome who contracted primary varicella infection and died in an intensive care unit less than 3 days from the onset of the symptoms.Two years before acquiring varicella infection, a 24-yearold Caucasian male was diagnosed with heterozygous FVL mutation following evaluation for a venous thrombosis. Subsequently, he became thrombocytopenic, and a diagnosis of myelodysplastic syndrome (MDS) was supported by bone marrow hypocellularity of 30%, and trisomy 8 karyotpe in 20% of marrow cell mitoses.…”

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confidence: 99%

Varicella fulminant hepatitis in an adult patient with Factor V Leiden mutation and trisomy 8 related myelodysplastic syndrome

Cattano

Vannucci

Nicolini

et al. 2008

Journal of Clinical Virology

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“…Although varicella is frequently associated with mild hepatitis, fulminant liver failure is rare 1. Only a few cases have been reported; these mainly occurred during a primary infection in patients with impaired immunity 1–7. We report here on the first case of an adult patient who underwent liver transplantation for fulminant liver failure related to a primary varicella infection.…”

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confidence: 97%

“…Adulthood and immunodepression are predisposing factors for visceral involvement, with interstitial pneumonitis and meningoencephalitis being the most common visceral complications. Although varicella is frequently associated with mild hepatitis, fulminant liver failure is rare 1. Only a few cases have been reported; these mainly occurred during a primary infection in patients with impaired immunity 1–7.…”

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confidence: 99%

Chickenpox-associated fulminant hepatitis that led to liver transplantation in a 63-year-old woman

et al. 2008

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A 63-year-old woman treated with prednisone for sinusitis developed fulminant liver failure due to a clinically unsuspected primary varicella zoster virus infection. The diagnosis of herpetic hepatitis was made from a liver biopsy, and varicella zoster virus viremia was detected by polymerase chain reaction. She was treated successfully with transplantation and perioperative administration of acyclovir. Liver Transpl 14:1309-1312, 2008. © 2008 AASLD. Received November 27, 2007 accepted February 25, 2008. Varicella or "chickenpox" is a very common and usually benign childhood disease due to a primary infection by the varicella zoster virus (VZV), which belongs to the alpha herpesvirus family. Up to 95% of the population is immunized during childhood, so varicella in adulthood is rare. Adulthood and immunodepression are predisposing factors for visceral involvement, with interstitial pneumonitis and meningoencephalitis being the most common visceral complications. Although varicella is frequently associated with mild hepatitis, fulminant liver failure is rare.1 Only a few cases have been reported; these mainly occurred during a primary infection in patients with impaired immunity. [1][2][3][4][5][6][7] We report here on the first case of an adult patient who underwent liver transplantation for fulminant liver failure related to a primary varicella infection. CASE REPORTOn July 23, 2005, a 63-year-old woman was admitted to a regional hospital for severe abdominal pain in the right lower quadrant with no fever. She had a history of asthma since the age of 20, requiring inhaled corticosteroids and bronchodilators. Ten days previously, she had suffered from sinusitis, which was treated with prednisone and pristinamycin for 7 days. At the time of admission, physical findings were not remarkable. Alanine aminotransferase and aspartate aminotransferase levels were 580 and 435 U/L respectively, with a normal prothrombin time and a white blood cell count (WBC) of 11 ϫ 10 3 /mm 3 . Abdominal ultrasound and chest X-ray findings were normal. Skin lesions were absent on the first day of admission. On day 2, a 2-cm-diameter cluster of clear vesicles on an erythematous base was noted on the right-hand surface of the abdomen, with no associated pruritus. This initial lesion was thought to be eczema. On day 3, this initial lesion progressed to pustules, and similar circular lesions were noted in the axillary cavities. In addition, several vesicles on an erythematous base appeared on the trunk. These lesions were considered to be impetigo, and local disinfection with eosin was performed, which impaired any further assessment of their course. On July 26, the patient's liver function worsened, and she was transferred to our intensive care unit for fulminant hepatitis. On admission, a clinical examination did Abbreviations: CMV, cytomegalovirus; HSV, herpes simplex virus; PCR, polymerase chain reaction; VZV, varicella zoster virus; WBC, white blood cell count. Address reprint requests to Anne-Marie Roque-Afonso,

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Fatal Varicella-Zoster Hepatitis Presenting with Severe Abdominal Pain: A Case Report and Review of the Literature

Cited by 17 publications

References 14 publications

Simultaneous Occurrence of Varicella Zoster Virus-Induced Pancreatitis and Hepatitis in a Renal Transplant Recipient: A Case Report and Review of Literature

Simultaneous Occurrence of Varicella Zoster Virus-Induced Pancreatitis and Hepatitis in a Renal Transplant Recipient: A Case Report and Review of Literature

Varicella fulminant hepatitis in an adult patient with Factor V Leiden mutation and trisomy 8 related myelodysplastic syndrome

Chickenpox-associated fulminant hepatitis that led to liver transplantation in a 63-year-old woman

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