Complication Of Varicella Zoster Infection Research Articles

Acute Disseminated Encephalomyelitis: A Rare Complication of Varicella Zoster Infection in an Adult

Acute Disseminated Encephalomyelitis: A Rare Complication of Varicella Zoster Infection in an Adult

An unusual case of Henoch-Schönlein purpura associated with varicella zoster infection

Henoch-Schonlein purpura (HSP) is one of the most common vasculitis of childhood which is characterized by nonthrombocytopenic palpable purpura, arthritis, renal and gastrointestinal system (GIS) involvement. The etiology of HSP is mainly unknown and antecedent upper respiratory tract infection, usually viral and Streptococcal origin, drugs, cold, insect bite or some foods are the known triggering factors. HSP is rarely triggered by varicella zoster infection. In this study, we present a case with HSP following varicella infection who was admitted to the hospital because of edema and erythema in the right ankle, palpable purpura in the lower extremities and crusted lesions of varicella in his back. As a result of the case, we believe that consideration of varicella zoster as a causative agent for HSP necessitates the vaccination against it which will prevent the development of many complications of varicella zoster infection including HSP. Key words: Henoch-Schonlein purpura, varicella zoster infection, nonthrombocytopenic purpura.

Varicella immunity and vaccine response in children with juvenile idiopathic arthritis treated with DMARD

Background There is a risk of developing serious complications of varicella zoster infection (VZI) in juvenile idiopathic arthritis (JIA) patients receiving disease modifying antirheumatic drugs (DMARD) including methotrexate and biologic agents [1,2]. Varicella zoster (VZ) immune status should therefore be checked in all children before starting such therapy. Seronegative children mostly receive varicella zoster vaccine (VZV). Vaccination may prevent worried parents and reduce the need for VZ immunoglobulin, intravenous acyclovir treatment and hospitalization.

Novel management of post varicella purpura fulminans owing to severe acquired protein S deficiency

Acquired protein S deficiency is a rare complication of varicella zoster infection often resulting in purpura fulminans, which is a potentially life-threatening syndrome of intravascular thrombosis and haemorrhagic infarction of the skin. Patients are presumed to develop crossreacting autoantibodies to the virus and protein S. There is no consensus on how best to manage these patients but previous recommendations focus on plasmapheresis and plasma exchange. We report the case of a 3-year-old girl with post varicella purpura fulminans owing to protein S deficiency, who was diagnosed promptly and made a full recovery following immediate treatment with anticoagulation and plasma support. This suggests that if anticoagulation is used, plasma exchange is not always necessary. As recovery occurred without plasmapheresis, we were able to track protein S levels. The timing of protein S recovery was consistent with the waning titre of an acquired immunoglobulin G autoantibody.

Cellulitis with Compartment Syndrome as a Complication of Varicella Zoster Infection

Varicella zoster infection (chickenpox) is a common and usually benign self limiting disease of childhood in non-vaccinated populations. Although varicella usually goes along with mild to moderate illness in immunocompetent patients, serious complications can arise. Varicella is highly infectious, with attack rates in susceptible individuals ranging from 61% to 100%. This case describes a rare but life threatening complication of varicella zoster infection in a child. High morbidity in non-vaccinated populations that led to rare cases of severe complications became a significant health burden all over the world. This aspect must be considered in the discussion about the importance and benefit of a population wide varicella vaccination programme as it was added to the childhood immunization schedule in Germany in 2004. The case described here might have been avoided by vaccination.

Optic neuritis heralding varicella zoster virus retinitis in a patient with acquired immunodeficiency syndrome.

We report on a 29-year-old severely compromised acquired immunodeficiency syndrome patient who developed retrobulbar optic neuritis 5 weeks after an episode of cutaneous herpes zoster infection. During the optic neuritis, varicella zoster virus could be demonstrated in the cerebrospinal fluid. The neuritis responded well to treatment with foscarnet, but, 3 weeks into therapy, varicella zoster retinitis developed. Additional treatment with intravenous acyclovir stopped progression of the retinitis and resulted in healing of the retinal lesions. This case suggests that retrobulbar optic neuritis can be regarded as a prodrome of imminent acute retinal necrosis. Early recognition and prompt therapy with combined antivirals may prevent the development of this devastating ocular complication of varicella zoster infection.

Granulomatous angiitis following primary varicella zoster infection

Granulomatous angiitis is an uncommon but well recognized complication of varicella zoster infection. The classic presentation is of a delayed hemiparesis in an often immunocompromised patient following zoster ophthalmicus. This report outlines the case of a young woman who developed a large left middle cerebral artery territory infarct secondary to granulomatous angiitis during primary varicella zoster infection.

Varicella pneumonitis: a role for extra-corporeal membrane oxygenation?

Pneumonitis is the most serious complication of varicella zoster infection and may be fatal despite antiviral therapy and assisted ventilation. We report two cases of varicella pneumonitis which were complicated by severe pneumonitis. Both patients deteriorated on maximal ventilatory support and were then given extra-corporeal membrane oxygenation (ECMO) and recovered. One patient subsequently developed lymphoma and the other was found to have an immunoglobulin subclass deficiency. ECMO should be considered for patients with varicella pneumonitis who do not respond to conventional treatment. Those with severe pneumonitis should be investigated for underlying immunodeficiency.