Disseminated Varicella Zoster and Multiorgan Failure Requiring ECMO Support in a Patient With Evans Syndrome

Visceral disseminated varicella-zoster virus (VD-VZV) infection is an uncommon but potentially life-threatening manifestation of varicella infection that primarily affects immunocompromised patients. When hematogenous dissemination occurs, the risk of significant organ dysfunction and death increases considerably. The disease develops through systemic viral spread to visceral organs, resulting in widespread multisystem involvement. Patients with Evans syndrome may be at increased risk because of underlying immune dysregulation and the frequent need for immunosuppressive treatment. We report the case of a 5-year-old unvaccinated child with Evans syndrome who developed severe multiorgan failure secondary to VD-VZV infection. The patient's condition was refractory to medical management but was successfully supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO), without bleeding complications despite profound thrombocytopenia. A modified anticoagulation strategy and aggressive platelet support were used. The patient was successfully decannulated after 8 days of ECMO without major hemorrhagic complications and subsequently recovered renal and hepatic function. This case highlights the fulminant nature of VD-VZV infection in an unvaccinated patient with Evans syndrome. It demonstrates that survival is possible with timely initiation of antiviral therapy and extracorporeal support.