Hemophagocytic lymphohistiocytosis secondary to Varicella zoster infection in a child with Henoch–Schönlein purpura

Abstract

Hemophagocytic lymphohistiocytosis (HLH) is a fatal, hyper-inflammatory syndrome that is characterized by untimely activation of macrophages, and manifests as cytopenia, organ dysfunction, and coagulopathy. Secondary HLH can be associated with infection, drugs, malignancy, and transplantation, and is mostly triggered by infection. Herein, we report the case of a patient with Henoch-Schönlein purpura (HSP) who developed severe HLH secondary to Varicella zoster infection.

IgA vasculitis with severe gastrointestinal symptoms may be an unusual manifestation of varicella zoster virus reactivation

“…Although IAV has been reported to develop before and after the appearance of varicella or zoster rash, no previous studies have identified the virus in both cutaneous and gastrointestinal lesions. Considering similarities between IAV and gastric zoster in the nature of abdominal pain and endoscopic findings in the gastrointestinal lesions, we hypothesize that IAV associated with gastrointestinal symptoms may result from varicella zoster virus (VZV) reactivation .…”

The importance of considering skin diseases from a temporal perspective: Special emphasis on the effects of corticosteroids and virally induced diseases

“…Because the typical vesicular eruptions could be entirely absent in some patients with abdominal zoster, 28 however, the diagnosis in the setting of the absence of cutaneous lesions (zoster sine herpete) can only be made by PCR analysis of blood or saliva and biopsy or autopsy samples. 3 Immunoglobulin A vasculitis (IAV) may develop before or after the appearance of varicella or zoster rash, 28,29 and therefore, we hypothesized that IAV associated with gastrointestinal symptoms results from VZV reactivation. 27 In these cases, herpetic lesions on the serosal and mucosal gut wall were observed at laparotomy.…”

“…In this regard, our previous immunohistochemical study clearly demonstrated that detection of VZV antigens in the eccrine epithelium can be used as a highly reliable and useful clue to the diagnosis of HZ with unusual manifestations and inflammatory dermatoses induced by VZV infection. 3 Immunoglobulin A vasculitis (IAV) may develop before or after the appearance of varicella or zoster rash, 28,29 and therefore, we hypothesized that IAV associated with gastrointestinal symptoms results from VZV reactivation. Consistent with this hypothesis, there are similarities in the nature of the abdominal pain and endoscopic findings in gastrointestinal lesions between patients with IAV and gastric or enteric zoster.…”

Efficacy of plasma exchange with a high dose of acyclovir for disseminated varicella infection

“…Although, in individuals treated with immunosuppressive therapies, the VZV infection can become disseminated and lead to a life-threatening condition [1][2][3][4][5]. Intravenous acyclovir (ACV), immunoglobulin, steroid pulse therapy, and plasma exchange (PE) are viable options for treating disseminated VZV infections [1][2][3][4][5]. However, there is currently no established treatment strategy for this life-threatening condition.…”