Varicella-Zoster Virus Gastritis: Case Report and Review of the Literature

• Published in: International journal of surgical pathology 2017-08, Vol.25 (5), p.449-452
• Main Authors: Nohr, Erik W., Itani, Doha M., Andrews, Christopher N., Kelly, Margaret M.
• Format: Article
• Language: English
• Subjects: Abdominal Pain - drug therapy; Abdominal Pain - etiology; Aged; Antineoplastic Agents - therapeutic use; Antiviral Agents - therapeutic use; Bile Ducts, Intrahepatic - pathology; Biopsy; Case reports; Chicken pox; Constriction, Pathologic - diagnosis; Constriction, Pathologic - pathology; Cytomegalovirus - isolation & purification; Delirium - drug therapy; Delirium - etiology; Endoscopy, Gastrointestinal; Esophagitis - complications; Esophagitis - drug therapy; Esophagitis - pathology; Esophagitis - virology; Exanthema - pathology; Exanthema - virology; Female; Gastric Mucosa - diagnostic imaging; Gastric Mucosa - pathology; Gastric Mucosa - virology; Gastritis - complications; Gastritis - drug therapy; Gastritis - pathology; Gastritis - virology; Herpesvirus 3, Human - isolation & purification; Herpesvirus 3, Human - pathogenicity; Humans; Immunohistochemistry; Immunosuppression - adverse effects; Immunosuppression - methods; Liver - pathology; Lymphoma - diagnostic imaging; Lymphoma - drug therapy; Nausea - drug therapy; Nausea - etiology; Neuralgia, Postherpetic - diagnosis; Neuralgia, Postherpetic - drug therapy; Neuralgia, Postherpetic - virology; Positron Emission Tomography Computed Tomography; Simplexvirus - isolation & purification; Skin - pathology; Skin - virology; Vaccines; Varicella Zoster Virus Infection - complications; Varicella Zoster Virus Infection - drug therapy; Varicella Zoster Virus Infection - pathology; Varicella Zoster Virus Infection - virology; Vomiting - drug therapy; Vomiting - etiology
• ISSN: 1066-8969; 1940-2465
• DOI: 10.1177/1066896917696751

We report varicella-zoster virus (VZV) gastritis in a 70-year-old woman postchemotherapy for lymphoma, presenting with abdominal pain, vomiting, and delirium without rash. A gastric biopsy demonstrated viral inclusions but posed a diagnostic challenge as immunohistochemistry for cytomegalovirus and herpes simplex virus were negative, and VZV immunohistochemistry was not available. The patient developed a vesicular rash 7 days after her symptoms began. Molecular testing of the gastric biopsy and a skin swab both confirmed VZV infection. She also had probable involvement of her liver and pancreas based on imaging and serum chemistry, and possible central nervous system involvement. She recovered with appropriate antiviral therapy but later developed a postherpetic neuralgia, and chronic intrahepatic biliary strictures; liver biopsy demonstrated a cholangiopathy of uncertain etiology. A literature review of the pathogenesis, epidemiology and sequelae of VZV infection is included.