Varicella-Zoster Virus-Associated Esophagogastritis.

Area of Science:

• Infectious Diseases
• Gastroenterology
• Oncology

Background:

• Varicella-zoster virus (VZV) reactivation in immunocompromised individuals can lead to disseminated disease.
• Gastrointestinal (GI) involvement by VZV is rare and often overlooked.
• Richter syndrome patients undergoing chemotherapy are at increased risk for opportunistic infections.

Purpose of the Study:

• To report a rare case of VZV-associated esophagogastritis in an immunocompromised patient.
• To highlight the importance of considering VZV in the differential diagnosis of unexplained GI symptoms in this population.
• To emphasize the role of early endoscopic evaluation and biopsy for diagnosis and treatment.

Main Methods:

• Case report of a 77-year-old male with Richter syndrome.
• Clinical presentation: abdominal pain, anorexia, fatigue, and disseminated skin lesions.
• Diagnostic procedures: vesicular fluid cytology, VZV antigen testing, esophagogastroduodenoscopy with biopsies, and immunohistochemical staining.

Main Results:

• Biopsy-proven VZV-associated esophagogastritis confirmed by immunohistochemistry and viral cytopathic changes.
• Esophageal and gastric biopsies showed positive VZV staining and characteristic changes.
• Intravenous acyclovir treatment led to significant improvement in both skin and GI lesions.

Conclusions:

• VZV-associated esophagogastritis is a rare but significant complication of disseminated VZV infection.
• Consider VZV in immunocompromised patients with unexplained GI symptoms, even before skin lesions appear.
• Timely diagnosis through endoscopy, biopsy, and virological testing is essential for effective management.