Abstract
We report the case of a 44-year-old man who developed a visceral varicella zoster virus (VZV) infection accompanied by severe organ failure. He had a history of tumor resections of non-metastatic colorectal cancer and testicular carcinoma. This patient was hospitalized because of stoma closure with concomitant severe abdominal pain. This abdominal pain was refractory to treatment with NSAIDs and pentazocine. Morphine chloride was needed to control his pain. All routine physical, laboratory and ultrasonographic studies were performed, but no diagnosis was revealed. The following day, the characteristic skin rash of VZV infection appeared over his entire body. Tzanck testing demonstrated herpes virus infection giant cells in the vesicular fluid, and varicella zoster virus DNA was detected in peripheral blood on polymerase chain reaction (PCR) analysis. We diagnosed this case as disseminated VZV infection. Acyclovir was started immediately. Further blood tests taken the following day revealed that the patient also had acute hepatitis and disseminated intravascular clotting. Since he did not respond to intravenous acyclovir (750mg/day), we increased the dose of acyclovir to 1,500mg/day and added intravenous immunoglobulin (IVIG). Soon after this therapy was initiated, the abdominal pain and skin rash improved. Commonly, VZV infection occurs in immunocompromised subjects, such as recipients of bone marrow transplantation. Disseminated VZV infection can present with acute abdominal pain prior to skin eruptions and is dangerous and often fatal. Early acyclovir administration and detection of VZV using PCR with blood or biopsy samples are recommended.Skin Research, 12: 212-218, 2013
