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Acute pancreatitis: presenting manifestation of varicella infection

Nirmaljeet S Malhi1, Usha Dutta, G Sathyanarayana

  • 1Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.

Tropical Gastroenterology : Official Journal of the Digestive Diseases Foundation
|October 9, 2004
PubMed

Insights

Varicella infection can present atypically in immunocompromised patients, mimicking acute pancreatitis. Early diagnosis and prompt antiviral therapy are crucial for managing this potentially fatal condition.

Area of Science:

  • Infectious Diseases
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Immunocompromised patients, particularly those on corticosteroids, are at increased risk for opportunistic infections.
  • Acute pancreatitis of unknown etiology necessitates a broad differential diagnosis, including infectious causes.
  • Varicella-zoster virus (VZV) infection can manifest with atypical presentations in immunocompromised individuals.

Observation:

  • A 29-year-old man on corticosteroids developed symptoms of acute pancreatitis.
  • During hospitalization, he developed a rash progressing from macular to papulovesicular, characteristic of varicella infection.
  • Liver function tests indicated anicteric hepatitis, and he later experienced fatal ventricular arrhythmia, suspected to be varicella myocarditis.

Findings:

  • The case highlights varicella infection as a potential, albeit rare, cause of acute pancreatitis in immunocompromised patients.
  • Atypical rash presentation and delayed onset relative to pancreatitis symptoms were noted.
  • The patient's outcome underscores the severity of disseminated VZV infection in this population.

Implications:

  • Clinicians should maintain a high index of suspicion for varicella infection in immunocompromised patients presenting with acute pancreatitis, even with atypical rash.
  • Prompt diagnostic testing for VZV is recommended for unexplained pancreatitis with any concurrent rash.
  • Early initiation of antiviral therapy, such as acyclovir, is critical for improving outcomes in severe varicella infections.

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