Varicella-Zoster Virus Gastritis: Case Report and Review of the Literature

Int J Surg Pathol. 2017 Aug;25(5):449-452. doi: 10.1177/1066896917696751. Epub 2017 Mar 1.

Abstract

We report varicella-zoster virus (VZV) gastritis in a 70-year-old woman postchemotherapy for lymphoma, presenting with abdominal pain, vomiting, and delirium without rash. A gastric biopsy demonstrated viral inclusions but posed a diagnostic challenge as immunohistochemistry for cytomegalovirus and herpes simplex virus were negative, and VZV immunohistochemistry was not available. The patient developed a vesicular rash 7 days after her symptoms began. Molecular testing of the gastric biopsy and a skin swab both confirmed VZV infection. She also had probable involvement of her liver and pancreas based on imaging and serum chemistry, and possible central nervous system involvement. She recovered with appropriate antiviral therapy but later developed a postherpetic neuralgia, and chronic intrahepatic biliary strictures; liver biopsy demonstrated a cholangiopathy of uncertain etiology. A literature review of the pathogenesis, epidemiology and sequelae of VZV infection is included.

Keywords: PCR; gastritis; immunocompromised host; pathology; varicella-zoster virus (VZV).

Publication types

  • Case Reports
  • Review

MeSH terms

  • Abdominal Pain / drug therapy
  • Abdominal Pain / etiology
  • Aged
  • Antineoplastic Agents / therapeutic use*
  • Antiviral Agents / therapeutic use
  • Bile Ducts, Intrahepatic / pathology
  • Constriction, Pathologic / diagnosis
  • Constriction, Pathologic / pathology
  • Cytomegalovirus / isolation & purification
  • Delirium / drug therapy
  • Delirium / etiology
  • Endoscopy, Gastrointestinal
  • Esophagitis / complications
  • Esophagitis / drug therapy
  • Esophagitis / pathology
  • Esophagitis / virology*
  • Exanthema / pathology
  • Exanthema / virology
  • Female
  • Gastric Mucosa / diagnostic imaging
  • Gastric Mucosa / pathology
  • Gastric Mucosa / virology
  • Gastritis / complications
  • Gastritis / drug therapy
  • Gastritis / pathology
  • Gastritis / virology*
  • Herpesvirus 3, Human / isolation & purification
  • Herpesvirus 3, Human / pathogenicity*
  • Humans
  • Immunohistochemistry
  • Immunosuppression Therapy / adverse effects*
  • Immunosuppression Therapy / methods
  • Liver / pathology
  • Lymphoma / diagnostic imaging
  • Lymphoma / drug therapy*
  • Nausea / drug therapy
  • Nausea / etiology
  • Neuralgia, Postherpetic / diagnosis*
  • Neuralgia, Postherpetic / drug therapy
  • Neuralgia, Postherpetic / virology
  • Positron Emission Tomography Computed Tomography
  • Simplexvirus / isolation & purification
  • Skin / pathology
  • Skin / virology
  • Varicella Zoster Virus Infection / complications
  • Varicella Zoster Virus Infection / drug therapy
  • Varicella Zoster Virus Infection / pathology
  • Varicella Zoster Virus Infection / virology*
  • Vomiting / drug therapy
  • Vomiting / etiology

Substances

  • Antineoplastic Agents
  • Antiviral Agents