Abstract
We report a case involving a 13 year-old-boy who first presented with severe abdominal pain and convulsion. He was ultimately diagnosed with varicella-zoster virus (VZV) reactivation following bone marrow transplantation (BMT). At 12 years of age, the patient was diagnosed with acute lymphoblastic leukemia. He underwent treatment with BMT from an HLA-matched related donor during the first complete remission. As chronic graft-versus-host disease occurred, treatment with cyclosporin and prednisolone was initiated. Six months after BMT, the patient complained of severe upper abdominal pain, which did not improve with the administration of H2-blocker or pentazocine. Three days after the onset of abdominal pain, the patient developed general convulsions. Magnetic resonance imaging (MRI) of his brain detected an abnormal T2 high-intensity lesion in the region surrounding the falxus cerebri. Upper gastrointestinal endoscopic findings suggested erosive esophagitis/gastritis. On the fourth day after symptom onset, vesicular rash covering his entire body was observed. A reactivation of VZV was diagnosed, and he was started on acyclovir therapy. Soon after the start of therapy, abdominal pain and skin rash improved. No recurrence of convulsion was detected. High anti-VZV antibody titers were observed, and VZV DNA was detected by an endoscopic biopsy probe (by polymerase chain reaction). The presenting symptoms of visceral VZV reactivation may lack skin rash. Early precise diagnosis is needed because of the high mortality associated with this disease.
