Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2020 Mar 6;7(1):e494.
doi: 10.1002/ams2.494. eCollection 2020 Jan-Dec.

Disseminated Varicella zoster infection with abdominal pain and periarterial fat stranding in a patient taking pomalidomide

Hiroaki Takada  1 , Saeko Kohara  1 , Takashi Ito  1 , Hayato Yoshioka  1 , Ichiro Okada  1 , Nobuaki Kiriu  1 , Yuichi Koido  1 , Eijyu Hasegawa  1
Affiliations
Case Reports

Disseminated Varicella zoster infection with abdominal pain and periarterial fat stranding in a patient taking pomalidomide

Hiroaki Takada et al. Acute Med Surg. .

Abstract

Background: Disseminated Varicella zoster virus infection (DVI) is a severe infection associated with severe abdominal pain of unknown cause. We report a case in which periarterial (the celiac artery and superior mesenteric artery) fat stranding (PFS) on computed tomography (CT) was the presumed cause of abdominal pain in a patient taking pomalidomide.

Case presentation: A 62-year-old woman was admitted to our hospital with abdominal pain. Her medical history was multiple myeloma treated with pomalidomide. Computed tomography showed no remarkable findings on admission, but 1 day later, a contrast-enhanced CT showed PFS. A skin eruption appeared on day 4 and we started acyclovir. On day 10, Varicella zoster virus antigen and antibody tests were positive, confirming the diagnosis of DVI. The abdominal pain subsequently improved, together with the PFS, and she was discharged.

Conclusion: When patients present with severe abdominal pain and PFS, DVI and acyclovir must be considered.

Keywords: Abdominal fat; Varicella zoster virus infection; gastroenterology and hepatology; pomalidomide; sepsis/multiple organ failure.

PubMed Disclaimer

Conflict of interest statement

Approval of the research protocol: N/A. Informed consent: Informed consent was obtained from the patient for publication of this case report. Registry and registration no. of the study/trial: N/A. Animal studies: N/A. Conflict of interest: None.

Figures

Figure 1
Figure 1
Fat stranding around the celiac and superior mesenteric arteries on the day after hospitalization of a 62‐year‐old woman with disseminated Varicella zoster infection. Periarterial fat stranding appeared around the superior mesenteric artery (arrow) on the day after hospitalization.
Figure 2
Figure 2
Fat stranding around the celiac and superior mesenteric arteries on day 21 of hospitalization of a 62‐year‐old woman with disseminated Varicella zoster infection. Periarterial fat stranding remained around the superior mesenteric artery (arrow) on day 21 of hospitalization.
Figure 3
Figure 3
Fat stranding around the celiac and superior mesenteric arteries on day 41 of hospitalization of a 62‐year‐old woman with disseminated Varicella zoster infection. Periarterial fat stranding around the superior mesenteric artery (arrow) had almost disappeared by day 41 of hospitalization.
See this image and copyright information in PMC

References

    1. Jong MD, Weel JFL, Oers MHJ, Boom R, Dillen PMEW. Molecular diagnosis of visceral herpes zoster. Lancet 2001; 357: 2101–2. - PubMed
    1. Yagi T, Karasuno T, Hasegawa T et al Acute abdomen without cutaneous signs of varicella zoster virus infection as a late complication of allogeneic bone marrow transplantation: importance of empiric therapy with acyclovir. Bone Marrow Transplant. 2000; 25: 1003–5. - PubMed
    1. Fujisato S, Urushibara T, Kasai H et al A fatal case of atypical disseminated herpes zoster in a patient with meningoencephalitis and seizures associated with steroid immunosuppression. Am. J. Case Rep. 2018; 19: 1162–7. - PMC - PubMed
    1. Curley MJ, Hussein SA, Hassoun PM. Disseminated herpes simplex virus and varicella zoster virus coinfection in a patient taking thalidomide for relapsed multiple myeloma. J. Clin. Microbiol. 2002; 40: 2302–4. - PMC - PubMed
    1. Nomdedéu JF, Nomdedëu J, Martino R et al Ogilvie’s syndrome from disseminated varicella‐zoster infection and infarcted celiac ganglia. J. Clin. Gastroenterol. 1995; 20: 157–9. - PubMed

Publication types