Varicella-Zoster Virus-Associated Esophagogastritis

Varicella-zoster virus (VZV) typically manifests as varicella or herpes zoster; however, in immunocompromised patients, viral reactivation may result in disseminated infection with visceral organ involvement. Gastrointestinal involvement is particularly rare and often underrecognized. We report a case of biopsy-proven VZV-associated esophagogastritis in a patient with Richter syndrome undergoing chemotherapy. A 77-year-old man was admitted with abdominal pain, anorexia, and fatigue. On hospital Day 3, he developed disseminated papulovesicular skin lesions. Cytologic examination of vesicular fluid revealed multinucleated giant cells, and antigen testing confirmed VZV infection. Esophagogastroduodenoscopy demonstrated erosions with white exudates in the esophagus and multiple gastric ulcers. Biopsy specimens from both the esophagus and stomach showed positive immunohistochemical staining for VZV. In addition, esophageal specimens exhibited characteristic viral cytopathic changes, including intranuclear inclusion bodies and multinucleation, confirming the diagnosis of VZV-associated esophagogastritis. Intravenous acyclovir therapy resulted in marked improvement of both cutaneous and gastrointestinal lesions. VZV-associated esophagogastritis is a rare but clinically significant manifestation of disseminated VZV infection. This condition should be considered in immunocompromised patients presenting with unexplained gastrointestinal symptoms, even before the appearance of characteristic skin lesions. Early endoscopic evaluation with biopsy and appropriate virological testing is essential for timely diagnosis and effective antiviral treatment.