Fulminant Multiorgan Failure Due to Varicella Zoster Virus and HHV6 in an Immunocompetent Adult Patient, and Anhepatia

Maggi, U.; Russo, Raffaela; Conte, G.; Chiumello, Davide; Lunghi, G.; Maggioni, Marco; Caspani, Maria Luisa; Arnoldi, Rossella; Dondossola, Daniele; Rossi, G.

doi:10.1016/j.transproceed.2011.01.142

Cited by 14 publications

(14 citation statements)

References 13 publications

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“…We identified 10 43-52 single case reports of VZV ALF in adults. All but 2 cases 45,49 were associated with immunosuppression and all but 1 case 47 also was associated with a rash and/or disseminated VZV clinical picture. We therefore did not identify any cases of adult VZV ALF that were not associated with a rash or disseminated clinical picture in a patient who had a competent immune system.…”

Section: Testing For Varicella Zoster Virus In Acute Liver Failurementioning

confidence: 99%

American Gastroenterological Association Institute Technical Review on Initial Testing and Management of Acute Liver Disease

et al. 2017

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Section: Testing For Varicella Zoster Virus In Acute Liver Failurementioning

confidence: 99%

American Gastroenterological Association Institute Technical Review on Initial Testing and Management of Acute Liver Disease

et al. 2017

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“…The diagnosis of liver disease due to VZV should always be clinically suspected in the presence of concurrent atypical skin lesions and a temporarily immunocompromised state. [12]…”

Section: Discussionmentioning

confidence: 99%

Maternal Death due to Viral Sepsis

Amararatne¹,

Vidanapathirana

2019

Medico-Legal J SL

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Sepsis accounts for approximately 10% of all maternal deaths and in pregnancy, as a result of cell-mediated immunity is altered and prone for infection. Varicella zoster virus (VZV) commonly causes chickenpox in children and herpes zoster in adults. In this case, viral sepsis probably due to VZV has caused a death of an apparently immune-competent young mother. A 19-year-old unmarried sex worker with Grave's disease presented in her second trimester with ankle oedema and shortness of breath. She was hypertensive and anaemic and was treated for secondary hypertension due to thyrotoxicosis. Later, she developed fever, oliguria and heart failure. She was treated in intensive care unit with hyperthyroid crisis induced by sepsis due to pneumonia. She developed high fever, intra-uterine death, hepato-renal failure, disseminated intravascular coagulation (DIC) and died on day fourteen. At autopsy, dermotomal vesicular skin lesions and vulval viral warts were seen. The internal organs showed sepsis. Blood for HIV was negative. Histopathology revealed viral pneumonia, myocarditis and DIC. Cause of death was given as sepsis due to viral pneumonia probably following VZV. The clinical diagnosis was septicaemia, due to pneumonia, but herpes zoster infection was not diagnosed. VZV infection can be life threatening even in immune-competent adults. The diagnosis of multi-organ failure from VZV should always be clinically suspected in the presence of atypical skin lesions and a temporarily immune-compromised state such as pregnancy.

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“…Another case reported from Italy was a 49-year-old man with no PMH except treatment for pharyngotonsillitis with steroids and antibiotics 15 days before presentation with retrosternal chest pain and truncal rash. He was treated with IV acyclovir, VZV immune globulin, and total hepatectomy, but was unable to receive a donor liver in time [ 6 ]. The next case was of a 15-year-old Roman male with no PMH who was treated with IV acyclovir, MARS (molecular adsorbent re-circulating system), and blood product transfusions.…”

Section: Discussionmentioning

confidence: 99%

Acute Liver Failure due to Disseminated Varicella Zoster Infection

Brewer

Hunter

2018

Case Reports in Hepatology

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Acute liver failure (ALF) can be due to numerous causes and result in fatality or necessitate liver transplantation if left untreated. Possible etiologies of ALF include ischemia, venous obstruction, medications, toxins, autoimmune hepatitis, metabolic and infectious causes including hepatitis A-E, varicella-zoster virus (VZV), cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), and adenovirus with VZV being the most rarely reported. Pathognomonic skin lesions facilitate diagnosis of VZV hepatitis, but definitive diagnosis is secured with liver biopsy, tissue histopathology, culture, and specific VZV polymerase chain reaction (PCR). Antiviral treatment with intravenous acyclovir can be effective if initiated in a timely manner; however, comorbidities and complications frequently result in high mortality, especially in immunocompromised hosts as exemplified in this case presentation.

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Fulminant Multiorgan Failure Due to Varicella Zoster Virus and HHV6 in an Immunocompetent Adult Patient, and Anhepatia

Cited by 14 publications

References 13 publications

American Gastroenterological Association Institute Technical Review on Initial Testing and Management of Acute Liver Disease

American Gastroenterological Association Institute Technical Review on Initial Testing and Management of Acute Liver Disease

Maternal Death due to Viral Sepsis

Acute Liver Failure due to Disseminated Varicella Zoster Infection

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