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      Varicella Zoster Infection: A Rare Cause of Abdominal Pain Mimicking Acute Abdomen

      case-report
      a , b , b , c
      Journal of Clinical Medicine Research
      Elmer Press

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          Abstract

          Varicella zoster is an acute viral infection that results from reactivation of a latent varicella zoster virus. It usually occurs in adult population and immune compromised patients. It rarely occurs in healthy children. Here we present a 14 years old male with varicella zoster that had abdominal pain mimicking acute abdomen to alert others who are consulted for the differentiation of acute abdomen and others who may be consulted for pain management.

          Keywords

          Varicella zoster; Abdominal pain

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          Most cited references11

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          A randomized clinical trial of analgesia in children with acute abdominal pain.

          To evaluate the effects of intravenous morphine on pain reduction, physical examination, and diagnostic accuracy in children with acute abdominal pain. A randomized, double-blind, placebo-controlled clinical trial was conducted at an emergency department of a tertiary care children's hospital. Children aged 5-18 years with abdominal pain of or =5 on a 0-10 visual analog scale, and need for surgical evaluation were eligible. Following the initial assessment, patients were randomized to receive either 0.1 mg/kg morphine or an equal volume of saline. The pediatric emergency medicine physician and surgical consultant independently recorded the areas of tenderness to palpation and percussion, and their diagnoses before the study medication and 15 to 30 minutes later. Sixty patients were enrolled, and 29 received morphine and 31 received saline. The demographic characteristics between the two groups were similar. The median reduction of pain score between the two study groups was 2 (95% CI = 1 to 4; p = 0.002). There was no significant change in the areas of tenderness in both study groups. Children with surgical conditions had persistent tenderness to palpation and/or percussion. There was no significant change in the diagnostic accuracy between the study groups and between the physician groups. All patients requiring laparotomy were identified and no significant complication was noted in the morphine group. Intravenous morphine provides significant pain reduction to children with acute abdominal pain without adversely affecting the examination, and morphine does not affect the ability to identify children with surgical conditions.
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            Acute abdomen without cutaneous signs of varicella zoster virus infection as a late complication of allogeneic bone marrow transplantation: importance of empiric therapy with acyclovir.

            Two patients complained of severe abdominal pain as the first sign of varicella zoster virus infection about 1 year after allogeneic BMT. In case 1, eruptions, found on the face and chest on admission, became vesicular and dispersed on the third hospital day. Though acyclovir (ACV) was immediately started, he died on the fourth day. In case 2, skin rash was never observed during the clinical course. Laparotomy on the third hospital day revealed many hemorrhagic spots on the liver surface and mucous membrane of the upper GI tract, indicating disseminated visceral disease. Empiric therapy with ACV was successful.
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              Visceral varicella zoster infection after bone marrow transplantation without skin involvement and the use of PCR for diagnosis.

              A 41-year-old patient with acute myeloid leukemia was transplanted from an HLA-identical but ABO-incompatible sibling. The post-transplant course was complicated by pure erythrocyte aplasia and mild chronic graft-versus-host disease. Eleven months after transplant while on steroid therapy she developed abdominal pain rapidly followed by fatal fulminant hepatic failure. Varicella zoster virus (VZV) was detected using the polymerase chain reaction from blood and liver obtained at necropsy even though no skin manifestations of VZV were present. This case confirms previous reports of visceral VZV infection in the absence of skin lesions thus emphasising the importance of suspecting the presence of VZV in this clinical setting and outlines the possible value of PCR in the rapid diagnosis of infection.
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                Author and article information

                Journal
                J Clin Med Res
                J Clin Med Res
                Elmer Press
                Journal of Clinical Medicine Research
                Elmer Press
                1918-3003
                1918-3011
                October 2009
                16 October 2009
                : 1
                : 4
                : 247-248
                Affiliations
                [a ]Izmir Bozyaka Training and Research Hospital, Department of Anaesthesiology, Bozyaka, Izmir, Turkey
                [b ]Izmir Bozyaka Training and Research Hospital, Department of Surgery, Bozyaka, Izmir, Turkey
                Author notes
                [c ]Corresponding author: email: naziferkan@ 123456gmail.com
                Article
                10.4021/jocmr2009.09.1259
                3299191
                22461879
                465d5f69-a115-448f-ad89-e80f42a440e6
                Copyright 2009, Olmez et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 August 2009
                Categories
                Case Report

                Medicine
                Medicine

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