This site needs JavaScript to work properly. A second case report from Spain was a 43-year-old male heart transplant recipient 9 months prior to the time of ALF from a VZV episode [3]. The exam was significant for oral thrush, but normal heart, lung, and abdominal exams. Less commonly, the rash can be more widespread and affect three or more dermatomes. A Periodic acid-Schiff stain with diastase did not show cytoplasmic globules. At that time, CBC, CRP, ESR, CK, and UA were within normal limits. Likewise, the AST to ALT ratio was not in the classic pattern (2:1) for alcoholic hepatitis. She also reported white “spots” in her mouth. 2005 Sep-Dec;7(3-4):116-21. doi: 10.1111/j.1399-3062.2005.00106.x. The virus migrates peripherally along axons into the skin. doi: 10.14309/crj.0000000000000044. She denied exposure to toxins, but had been on prophylactic trimethoprim/sulfamethoxazole for long duration; this was a consideration for drug induced liver injury, but was refuted by biopsy, PCR, and culture results. Thus, varicella vaccine prevents disseminated varicella infection by protecting against natural infection. Varicella-zoster is the virus that causes varicella (chicken pox), herpes zoster (shingles), and rarely, severe disseminated disease including diffuse rash, encephalitis, hepatitis, and pneumonitis. World J Gastroenterol. Background Herpes zoster (HZ) is caused by reactivation of latent varicella-zoster virus (VZV) infection. In review of the literature, only 8 adult cases of acute liver failure from VZV were found, of which only 2 survived [2–9]. 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. 2019 Dec 4;11(12):e6286. The patient’s dermatologist had performed skin biopsies 2 days prior to admission that showed multinucleated giant cells with viral inclusions suggestive of some type of herpes virus infection (Figures 3–5). doi: 10.7759/cureus.6286. 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. Herpes zoster is a reactivation of latent varicella infection. Dissemination typically occurs 4-11 days after the onset of localized cutaneous disease. Lipase was 675 U/L and CMP was remarkable for sodium 129 mEq/L, amino alanine transferase (ALT) 158 U/L, and aspartate aminotransferase (AST) 111 U/L; the rest of the CMP including alkaline phosphatase (ALP) was normal. Varicella-zoster is the virus that causes varicella (chicken pox), herpes zoster (shingles), and rarely, severe disseminated disease including diffuse rash, encephalitis, hepatitis, and pneumonitis. Shallal A, Patel P, Reaume M, Tariq T, Garg D. ACG Case Rep J. Varicella zoster virus can cause two clinical syndromes, primary (chickenpox) and secondary (herpes zoster). Human alphaherpesvirus 3 (HHV-3), usually referred to as the varicella-zoster virus (VZV), is one of nine herpesviruses known to infect humans. Viral pneumonia caused by varicella-zoster virus (VZV) infection is a rare but important complication, es-pecially regarding varicella infections. Until all lesions are crusted over or when chickenpox/varicella zoster (shingles) infection have been ruled out. It results from reactivation of latent herpes varicella-zoster (chickenpox) virus residing in dorsal root or cranial nerve ganglion cells. The virus then establishes latency in the dorsal root ganglia and can later reactivate as “shingles” or herpes zoster, a localized dermatomal vesicular eruption. Disseminated zoster . The infectious VZV antigen detected by direct fluorescent antibody test; or • VZV-specific nucleic acid detected by polymerase chain reaction (PCR). In disseminated zoster, the rash is more widespread and affects 3 or more dermatones. Patients with disseminated disease or severe immunosuppression or who are unresponsive to therapy should be transferred to a higher level of care. Varicella Zoster Virus Esophagitis in an Immunocompetent Patient. R. J. Whitley, “Herpesviruses,” in Medical Microbiolog… Shingles has no relationship to season and does not occur in epidemics. Although disseminated cutaneous herpes zoster (DCHZ) is often asso-ciated with visceral diseases, there have been few reports of … Get the latest research from NIH: https://www.nih.gov/coronavirus. We report 2 cases of atypical disseminated HZ in immunocompromised patients presenting … 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). Disseminated varicella zoster is most common in immunocompromised patients [1]. There was no bile duct injury, paucity, or vasculitis. (4) Disseminated VZV with ALF has a very high mortality rate. In these cases, IV acyclovir was the staple of treatment [2, 3]. This attenuated VZV vaccine is generally well tolerated, although, in 3.8% of patients, a localized varicella-like rash can occur 4–8 weeks after vaccination [2]. Herpes zoster affects 10% to 20% of the United States population. Significant laboratory data was as follows: AST 1389 U/L, ALT 1570 U/L, ALP 68 U/L, international normalized ratio (INR) 1.6, and prothrombin time (PT) 18 seconds. VZV immune globulin was considered as therapy, but IVIG was administered instead due to her severe coagulopathy and thrombocytopenia. 2020 Jul 4;21:e00902. USA.gov. For localized zoster, exposures include those with intimate contact (i.e., changing bandages, touching, hugging). Review articles are excluded from this waiver policy. ... (800 mg five times daily). The virus then establishes latency in the dorsal root ganglia and can later reactivate as “shingles” or herpes zoster, a localized dermatomal vesicular eruption. Acute pancreatitis associated with herpes zoster: case report and literature review. PCR was negative for HSV, EBV, and CMV and positive for VZV. Cutaneous and extracutaneous dissemination can occur, most commonly in immunocompromised patients [1 1. As part of her liver transplant evaluation, extensive serologic investigation ensued. eCollection 2020. Diagnosis was confirmed with a post mortem liver analysis [7]. The varicella zoster virus is highly infectious, spreading via direct contact or respiratory droplets, and can lead to life-threatening complications. Resultant fulminant liver failure from VZV is even more rare and deadly. Primary infection presents mainly in children with a generalized vesicular rash. Management of exposed individuals Evaluate evidence of immunity to varicella in all individuals exposed to zoster. Copyright © 2018 Elizabeth Caitlin Brewer and Leigh Hunter. CXR was normal and abdominal radiograph showed evidence of constipation. He received supportive care and was diagnosed post mortem [4]. Blood PCRs were positive with high levels of VZV and low levels of CMV. 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