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• W2978561699 abstract "Disseminated varicella zoster (VZV) infection can involve intra-abdominal organs including the spleen, liver, and pancreas and has a reported mortality of up to 50%. Diagnosis is often delayed because the vesicular rash may appear days after abdominal pain develops. We describe a case of disseminated VZV mimicking pancreatitis and hepatitis and review the existing literature. A 66 woman with B-cell CLL, treated with idelalisib was admitted with new onset, epigastric pain radiating to the back. Initial CT scan of the abdomen was normal. Lipase and liver enzymes were normal upon admission. She was treated conservatively with fluids and pain management however developed worsening abdominal pain and confusion. Over the next week, lipase rose to 784 U/L, and AST 4,538 U/L. Serial CT imaging finally demonstrated fluid around the pancreas and on hospital day 4 she developed a vesicular truncal rash (Figure 1). Tzanck prep on skin biopsy was positive for herpes virus. Additionally esophageal biopsies by EGD demonstrated VZV ulcerations. She was initiated on high dose IV acyclovir however despite 3-months of therapy deteriorated and succumbed to complications of disseminated VZV. The diagnosis of Visceral VZV is commonly delayed with mortality rates from in 3/31 (9.7%) immunocompetent individuals, 25/88 (28.4%) in individuals with malignancy, and 5/6 (83.3%) in immunosuppressed individuals with no evidence of malignancy. A vesicular rash presents on average about 6 days after the onset of abdominal pain in patients with malignancy, 2.5 days in immunosuppressed patients, and on the same day of pain in immunocompetent individuals. Patients with a history of hematological malignancy or bone marrow suppression are at higher risk. Visceral VZV may mimic hepatitis, pancreatitis, and esophagitis which may also delay the diagnosis. Early salivary testing for VZV may be diagnostic prior to the presentation of a rash, and early treatment with IV acyclovir may be lifesaving though up to 50% of patients may still succumb to VZV despite receiving prolonged treatment. A high index of suspicion is required to diagnose visceral VZV and should be considered particularly in patients with hematological malignancy with refractory abdominal pain. Early salivary PCR testing and early antiviral therapy should be initiated which may help reduce morbidity and mortality associated with this uncommon condition.Figure 1" @default.
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• W2978561699 date "2016-10-01" @default.
• W2978561699 modified "2023-09-24" @default.
• W2978561699 title "Visceral Zoster: an Elusive Cause of Abdominal Pain in Immunocompromised Patients" @default.
• W2978561699 doi "https://doi.org/10.14309/00000434-201610001-02120" @default.
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