title: Varicella with rapidly progressive hepatitis presenting with multiple hepatic nodules in a child with acute leukemia.
abstract: Abdominal pain may precede the characteristic varicella skin lesions in immunocompromised patients with visceral varicella. The absence of skin lesions may delay timely diagnosis and treatment of varicella for those patients. Furthermore, abdominal imaging findings to provide information to diagnose visceral varicella have rarely been reported. Varicella was diagnosed in a 5-year-old boy with acute lymphoblastic leukemia complaining of fever and abdominal pain followed by papulovesicular skin lesions. Later, the patient was found to have rapidly progressive acute hepatitis, and abdominal computed tomography showed multiple hypodense hepatic nodules. The patient was treated with intravenous acyclovir, intravenous immunoglobulin, and empirical antibiotic and antifungal therapy. However, his fever and abdominal pain persisted, and a laparoscopic liver biopsy was performed to differentiate other causes of the persisting symptoms. Eventually, the patient was diagnosed with visceral varicella based on histopathologic findings. In conclusion, visceral varicella should be considered in immunocompromised patients with abdominal pain and multiple hypodense hepatic nodules on abdominal imaging studies. However, bacteria, fungi, and tuberculosis can produce similar imaging findings; therefore, a biopsy may be necessary in patients not responding to antiviral therapy.
authors: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Seung Beom
authors: SB
authors: Han
authors: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Young Eun
authors: YE
authors: Seo
authors: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Seong-Koo
authors: SK
authors: Kim
authors: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea. Electronic address: dashwood@catholic.ac.kr.
authors: Jae Wook
authors: JW
authors: Lee
authors: Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Dong-Gun
authors: DG
authors: Lee
authors: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Nack-Gyun
authors: NG
authors: Chung
authors: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Bin
authors: B
authors: Cho
authors: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Jin Han
authors: JH
authors: Kang
authors: Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Catholic Blood and Marrow Transplantation Center, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Hack-Ki
authors: HK
authors: Kim
authors: Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors: Eun Sun
authors: ES
authors: Jung
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D000208:Acute Disease; D002644:Chickenpox / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D002675:Child, Preschool; D018450:Disease Progression; D006505:Hepatitis / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008099:Liver / Q000473:pathology*; D008297:Male; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000473:pathology*
keywords: Acute lymphoblastic leukemia; Chickenpox; Child; Hepatitis; Varicella-zoster virus