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Pseudotumour cerebri after varicella
D Konrad1, H Kuster, U A Hunziker
1Kinderklinik, Kantonsspital Winterthur, Switzerland. dkonrad@kispi.unizh.ch
Insights
Varicella (chickenpox) can cause blood clots in children, potentially due to anti-protein S antibodies. Prompt treatment is crucial for managing these thrombotic events.
Area of Science:
- Pediatric Thrombosis
- Infectious Disease Complications
- Autoimmunity
Background:
- Varicella (chickenpox) is a common childhood viral infection.
- Thrombotic complications, though known, are less frequently discussed in pediatric varicella cases.
- Protein S deficiency has been implicated in some thrombotic events.
Observation:
- An 8-year-old girl developed pseudotumor cerebri with abducens palsy and ileofemoral vein thrombosis three weeks post-varicella.
- Laboratory tests revealed transient anti-protein S auto-antibodies.
- Initial treatment with heparin resolved the pseudotumor cerebri but not the deep vein thrombosis.
Findings:
- The case suggests a link between varicella infection and the development of anti-protein S antibodies.
- These antibodies may lead to transient protein S deficiency, contributing to thrombotic events.
- The specific presentation included both intracranial hypertension and deep vein thrombosis.
Implications:
- Thrombotic complications following varicella may be mediated by auto-antibodies against protein S.
- Early identification of anti-protein S antibodies is critical for effective treatment.
- Recombinant tissue-type plasminogen activator may be a beneficial therapeutic option for severe cases.
Unlabelled:
Thrombotic complications in children with varicella are well known. Transient protein S deficiency due to the presence of an anti-protein S antibody seems to be responsible at least in part. In an 8-year-old girl, pseudotumour cerebri with abducens palsy and ileofemoral vein thrombosis occurred 3 weeks after chickenpox. A transient elevation of anti-protein S auto-antibodies was identified. Under treatment with heparin the pseudotumour cerebri rapidly disappeared but the iliofemoral thrombosis persisted.
Conclusion:
Thrombotic complications after varicella might be mediated at least in part by antibodies against protein S. Early recognition of this condition permits appropriate treatment with recombinant tissue-type plasminogen activator.