Gastric Ulcers Due to Varicella-Zoster Reactivation

Author:

Milligan Ki Lee1,Jain Ajay Kumar12,Garrett Jeremy S.13,Knutsen Alan P.14

Affiliation:

1. Department of Pediatrics,

2. Divisions of Gastroenterology,

3. Critical Care, and

4. Allergy & Immunology, Saint Louis University, St Louis, Missouri

Abstract

We report on an 18-year-old man with common variable immunodeficiency presenting with abdominal pain and vomiting due to gastric ulcers caused by reactivation of varicella-zoster virus (VZV). Endoscopy revealed multiple ulcers in the gastric antrum. Fever and rash developed the next day. Skin biopsy showed multinucleated cells with intranuclear inclusions highly suggestive of VZV infection, and high-dose intravenous acyclovir was started. VZV was detected on direct immunofluorescence from skin biopsy and polymerase chain reaction from endoscopic biopsy. His course was complicated by encephalopathy, pancreatitis, hepatitis, renal impairment, and hyponatremia. After 3 weeks of antiviral therapy, he gradually improved. Skin lesions cleared within a week. He remained well on follow-up 1 year later. Disseminated zoster presenting as gastric ulcers in the absence of the classic rash is unusual but has been reported in immunosuppressed patients with a history of bone marrow and stem cell transplant. We report this rare presentation in a patient with common variable immunodeficiency and highlight the importance of considering zoster as a cause for severe abdominal pain and of seeking endoscopic diagnosis to facilitate early therapy and reduced mortality risk.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology and Child Health

Reference27 articles.

1. Visceral varicella-zoster after bone marrow transplantation: report of a case series and review of the literature.;David;Am J Gastroenterol,1998

2. Prevention of VZV infection in immunosuppressed patients using antiviral agents.;Boeckh;Herpes,2006

3. Varicella-Zoster Infections;American Academy of Pediatrics,2009

4. Acute abdomen by varicella zoster virus induced gastritis after autologous peripheral blood stem cell transplantation in a patient with non-Hodgkin’s lymphoma.;Scholl;Acta Haematol,2006

5. Visceral varicella zoster infection after bone marrow transplantation without skin involvement and the use of PCR for diagnosis.;Rogers;Bone Marrow Transplant,1995

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