Demonstration of Varicella-Zoster Virus Infection in the Muscularis Propria and Myenteric Plexi of the Colon in An HIV-Positive Patient With Herpes Zoster and Small Bowel Pseudo-Obstruction (Ogilvie's Syndrome)

Pui, John; Furth, Emma E.; Minda, Justina M.; Montone, Kathleen T.

doi:10.1111/j.1572-0241.2001.03808.x

Cited by 54 publications

(51 citation statements)

References 11 publications

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“…The present case illustrates that acute colonic pseudo-obstruction (Ogilvie's syndrome) can be produced by VZV infection and that it usually occurs in immunocompromised persons (4,(9)(10)(11)(12)(13)(14)(15)(16)(17). VZV-induced Ogilvie's syndrome carries significant rates of morbidity and mortality, and its diagnosis requires a high index of suspicion because visceral symptomatology may antecede the appearance of the characteristic skin eruption (11,14).…”

Section: Case Reportmentioning

confidence: 89%

“…VZV-induced Ogilvie's syndrome carries significant rates of morbidity and mortality, and its diagnosis requires a high index of suspicion because visceral symptomatology may antecede the appearance of the characteristic skin eruption (11,14). However, the coexistence of herpes zoster and Ogilvie's syndrome is uncommon and has received scant attention in the medical literature.…”

Section: Case Reportmentioning

confidence: 99%

“…In this regard, various hypotheses have been proposed to explain the origin of colonic dilatation. The first is parietal and visceral peritoneal inflammation linked to vesicular eruption (14). The second is viral involvement of the extrinsic autonomic nervous system, either through infection of anterior horn motor neurons or by involvement of the celiac plexus ganglion (14).…”

Section: Case Reportmentioning

confidence: 99%

“…The first is parietal and visceral peritoneal inflammation linked to vesicular eruption (14). The second is viral involvement of the extrinsic autonomic nervous system, either through infection of anterior horn motor neurons or by involvement of the celiac plexus ganglion (14). The third refers to direct VZV injury of both the ENS (submucosal and myenteric plexuses) and the colonic muscularis propria (4,14).…”

Section: Case Reportmentioning

confidence: 99%

“…The second is viral involvement of the extrinsic autonomic nervous system, either through infection of anterior horn motor neurons or by involvement of the celiac plexus ganglion (14). The third refers to direct VZV injury of both the ENS (submucosal and myenteric plexuses) and the colonic muscularis propria (4,14). Another hypothesis suggests hemorrhagic infarction of the abdominal sympathetic ganglia as the main mechanism of the colonic pseudo-obstruction (16).…”

Section: Case Reportmentioning

confidence: 99%

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Varicella-Zoster Virus (VZV) Infection as a Possible Cause of Ogilvie's Syndrome in an Immunocompromised Host

Carrascosa¹,

Salcines-Caviedes²,

Gómez-Román

et al. 2014

J Clin Microbiol

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We describe an immunodeficient adult with Ogilvie's syndrome preceding a disseminated papulovesicular skin rash in whom varicella-zoster virus infection was demonstrated by PCR assay in cutaneous and colonic biopsy specimens. In view of the significant morbidity and mortality that this condition carries, early and accurate molecular diagnosis and timely treatment are strongly recommended. CASE REPORTA 62-year-old white man was admitted in June 2013 because of a 6-day history of severe and worsening abdominal pain and vomiting. He had been diagnosed with stage IIIA, diffuse large B-cell lymphoma in 2004, when complete remission was achieved following immunochemotherapy (rituximab, cyclophosphamide, adriamycin, vincristine, and prednisone [R-CHOP]). In 2008, he received immunochemotherapy as a salvage treatment for relapse (rituximab, etoposide, cytarabine, cisplatinum, and methylprednisolone [R-ESHAP]) and an autologous hematopoietic stem-cell transplant, reaching complete remission once more. Afterwards, the patient was given consolidation chemotherapy until October 2012, bendamustine being the last agent prescribed. A positron emission tomography scan performed in May 2013 displayed normal findings. His medical history also included diabetes mellitus and an episode of herpes zoster on the right T 12 dermatome 15 months before admission. He denied opiate, phenothiazines, or calcium channel blocker administration, chronic constipation, or recent trauma or surgical intervention. He was not on immunosuppressive therapy.On admission, the patient was afebrile and hemodynamically stable. Physical examination revealed profound abdominal distention and decreased bowel sounds but no signs of peritoneal irritation. Blood tests were significant for leucopenia and lymphopenia (2.3 ϫ 10 9 /liter leukocytes, 71.4% neutrophils, 16.8% lymphocytes), mild anemia (hemoglobin, 119 g/liter), and an accelerated erythrocyte sedimentation rate (45 mm/h). His total Tcell count and CD4 ϩ T-cell count were 0.317 ϫ 10 9 /liter and 0.012 ϫ 10 9 /liter, respectively. An abdominal computed tomography (CT) scan showed marked colonic dilatation and a possible narrowing at the rectosigmoid junction; pneumoperitoneum or ascites were absent (Fig. 1). An ensuing colonoscopy ruled out strictures and was remarkable only for a solitary sigmoidal ulcerative lesion (Fig. 2) which was subjected to a biopsy procedure (Fig. 3). Simultaneous control biopsy specimens taken from an endoscopically normal right colon revealed normal findings. An upper gastrointestinal endoscopy displayed no abnormalities. At that time, emergency, internal medicine, and surgery physicians were unable to ascertain the origin of the large bowel distension.Moreover, the patient's complaints required intravenous tramadol, paracetamol, and metamizole treatment. On the third hospital day, he developed a cutaneous, diffuse exanthematous papulovesicular rash most consistent with disseminated herpes zoster (Fig. 4)-one of these lesions was subjected to a biopsy procedure on the same day...

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Section: Case Reportmentioning

confidence: 89%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

Section: Case Reportmentioning

confidence: 99%

See 3 more Smart Citations

Varicella-Zoster Virus (VZV) Infection as a Possible Cause of Ogilvie's Syndrome in an Immunocompromised Host

Carrascosa¹,

Salcines-Caviedes²,

Gómez-Román

et al. 2014

J Clin Microbiol

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Acute pancreatitis in immunocompromised patients: beware of varicella zoster virus primo‐infection

Picod

Corre

Maury

et al. 2017

Clinical Case Reports

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Latent and lytic infection of isolated guinea pig enteric ganglia by varicella zoster virus

et al. 2003

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Varicella zoster virus (VZV) has been demonstrated to infect guinea pig enteric neurons in vitro. Latent infection of isolated enteric neurons is established when the cultures predominantly consist of neurons and they are exposed to cell-free VZV. Neurons harboring latent infection survive for weeks in vitro and express mRNA encoding ORFs 4, 21, 29, 40, 62, and 63, but not 14(gC) or 68 (gE) (although DNA encoding the glycoproteins is present). The expressed proteins are the same as those that are also expressed in human sensory neurons harboring latent VZV. In addition to mRNA, the immunoreactivities of ORFs 4, 21, 29, 62, and 63 can be detected. ORF 62 and 29 proteins are cytoplasmic and not intranuclear. VZV does not preferentially infect and/or become latent in intrinsic enteric primary afferent neurons indicating that the virus is latent in these neurons. Lytic infection occurs when mixed cultures of neurons and non-neuronal cells of the bowel wall are exposed to cell-free VZV or when isolated enteric neurons are exposed to cell-associated VZV. When lytic infection occurs, enteric neurons die within 48 hr. Prior to their death, neurons express VZV glycoproteins, including gE and gB, and ORF 62 and 29 proteins are intranuclear. This new animal model should facilitate studies of VZV latency and the efficacy of therapies designed to prevent VZV infection, latency, and reactivation.

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Demonstration of Varicella-Zoster Virus Infection in the Muscularis Propria and Myenteric Plexi of the Colon in An HIV-Positive Patient With Herpes Zoster and Small Bowel Pseudo-Obstruction (Ogilvie's Syndrome)

Cited by 54 publications

References 11 publications

Varicella-Zoster Virus (VZV) Infection as a Possible Cause of Ogilvie's Syndrome in an Immunocompromised Host

Varicella-Zoster Virus (VZV) Infection as a Possible Cause of Ogilvie's Syndrome in an Immunocompromised Host

Acute pancreatitis in immunocompromised patients: beware of varicella zoster virus primo‐infection

Latent and lytic infection of isolated guinea pig enteric ganglia by varicella zoster virus

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