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Volume 32, Issue 3, September 2021




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Mediterr J Rheumatol 2021;32(3):280-4
Visceral Varicella-Zoster Virus Infection Presenting with Severe Abdominal Pain without a Rash in a Patient with Psoriatic Arthritis Treated with Infliximab Biosimilar and Steroids: A Case Report
Authors Information

1. Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
2. Department of Radiology, University Hospital of Heraklion, Heraklion, Greece
3. Department of Rheumatology, University Hospital of Heraklion, Heraklion, Greece
4. Department of Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece

N Spernovasilis, M Raissaki

Abstract

Visceral herpes zoster following reactivation of dormant varicella-zoster virus can rarely occur, usually in highly immunosuppressed patients, and may present with abdominal pain without the relevant rash. In the absence of skin manifestations, diagnosis of visceral herpes zoster is extremely difficult, while computed tomography may reveal isolated periarterial fat stranding. We describe a rare case of visceral herpes zoster in a medically immunocompromised adult with psoriatic arthritis, who presented with acute abdomen, was diagnosed based on computed tomography findings and subsequent serum polymerase chain reaction results, and was appropriately treated with an uneventful recovery. This case underlines the significance of considering varicella-zoster virus infection as a cause of severe abdominal pain even in the absence of rash in this setting, and highlights the potential role of appropriately performed computed tomography in such unusual and complex cases, where early diagnosis and initiation of treatment is extremely important for a favorable outcome.



Article Submitted:11 Nov 2020; Revised Form: 8 Mar 2021; Article Accepted: 30 Mar 2021; Available Online: 25 Jun 2021

https://doi.org/10.31138/mjr.32.3.

This work is licensed under a Creative Commons Attribution 4.0 International License (CC-BY). 

©Spernovasilis N, Raissaki M, Papakitsou I, Pitsigavdaki S, Louka K, Tavlas E, Kofteridis DP.