First case report of pulmonary embolism with Zoster Sine Herpete

Abstract

Background Varicella-Zoster Virus (VZV) infection is known to cause coagulation abnormalities leading to pulmonary embolism and ischemic strokes. The incidence of vascular and thrombotic complications with Zoster Sine Herpete has been reported very infrequently in the medical literature. Case presentation A 32-year-old man with no significant past medical history presented to Emergency Room with right-sided facial weakness and headache. We saw no rash on physical examination. A sub-segmental pulmonary embolus was found on C.T. angiography of the chest. VZV was detected on Lumbar Puncture studies. The patient responded well to anti-viral treatment and was discharged home without any complications. Conclusion The suspicion of thrombo-embolic complications should be high with Zoster Sine Herpete. Screening for coagulopathies and timely initiation of anticoagulation should be carried out in appropriate clinical settings.

Deep Venous Thrombosis - A Rare Complication of Herpes Zoster

“…Thrombotic complications secondary to varicella infection were mainly described in children, however few case reports were documented in adults. Examples of them are cortical venous thrombosis, pulmonary thromboembolism, tibial artery thrombosis, Deep venous thrombosis of legs (Mehkri et al, 2022) (Salvotti et al, 2023) (Sahra et al, 2021) (Peyton et al, 1998) (Maity et al, 2014). The underlying pathology for the increased risk of thrombosis was due to endothelial cell damage and procoagulant state.…”

Atypical varicella-zoster virus reactivation: a case report

“…The first case report of pulmonary embolism associated with zoster sine herpete was described by Sahra et al in 2021 [14] .…”

“…Thrombotic complications are mainly described in children [ 6 ] , but a few isolated cases of VZV-related CVST and other deep-vein thromboses have been reported in adults [ 7 , 11 – 13 ] . The first case report of pulmonary embolism associated with zoster sine herpete was described by Sahra et al in 2021 [ 14 ] .…”

“…As far as treatment is concerned, VZV-associated vasculopathy is traditionally treated with intravenous acyclovir, and a prompt anticoagulation can prevent a potentially fatal outcome [ 14 ] . Early diagnosis and management help to prevent associated morbidity and mortality, and produce a good prognosis [ 6 , 8 ] .…”