Olmez et al ration [4]. In one series of 121 ‘negative’ emergency lapa- rotomies, 3 occurred in patients with varicella zoster virus. Some relatively common diseases must be considered in the differential diagnosis of acute abdominal pain. The pain can be confusing, particularly if the nerves in the right lower quadrant are involved in a patient whose appendix has not been removed. When our patient admitted to hospital, he had abdominal pain mimicking acute abdomen like ap- pendicitis. Another disease in the differential diagnosis is Meckel’s diverticulitis, in which abdominal pain is usually in the left lower abdomen but can be anywhere. Elevated white blood cell count presented. Peritonitis, urinary tract infection, gastroenteritis, pneumonia were considered in the differential diagnosis. The patient was not given analgesic. Recent surveys suggest that many physicians believe conservative adminis- tration of pain medication does not interfere with diagnosis and treatment of patients with acute abdominal pain [9, 10]. Despite this recognition, the difference between understand- ing and practice remains large and abdominal pain is often under-treated as it had happened in our case. In the absence of rash, the diagnosis can be made using polymerase chain reaction (PCR) analysis of blood or fecal samples [11]. Although PCR is the most sensitive method, it is still very expensive and not widely available. Antiviral treatment is usually delayed until cutaneous signs of the in- fection appear. In summary, varicella zoster should be suspected in children who have acute abdominal pain but no characteris- tic skin eruptions. We report this patient to alert others who are consulted for the differentiation of acute abdomen and others who may be consulted for pain management. References 1. Brodell RT, Zurakowski JE. Childhood shingles. Herpes zoster can occur in healthy children too. Postgrad Med 2004;115(4):63-65. J Clin Med Res • 2009;1(4):247-248 2. Gucuyener K, Citak EC, Elli M, Serdaroglu A, Citak FE. Complications of varicella zoster. Indian J Pediatr 2002;69(2):195-196. 3. Phuah HK, Chong CY, Lim KW, Cheng HK. Complicat- ed varicella zoster infection in 8 paediatric patients and review of literature. Singapore Med J 1998;39(3):115- 120. 4. Magdiev T, Kuznetsov VD, Shipilov VA, Severinko NV. [Erroneous laparotomy in emergency surgery]. Khirur- giia (Mosk) 199111):118-122. 5. O’Loughlin CJ, Karnam US, Barkin JS. Visceral vari- cella zoster after bone marrow transplantation: an obscure cause of an “acute abdomen”. Dig Dis Sci 2002;47(9):1962-1964. 6. Yagi T, Karasuno T, Hasegawa T, Yasumi M, Kawamoto S, Murakami M, Uosima N, et al. Acute abdomen with- out cutaneous signs of varicella zoster virus infection as a late complication of allogeneic bone marrow trans- plantation: importance of empiric therapy with acyclo- vir. Bone Marrow Transplant 2000;25(9):1003-1005. 7. Munoz L, Balmana J, Martino R, Sureda A, Rabella N, Brunet S. [Abdominal pain as the initial symptom of vis- ceral varicella zoster infection in hematopoietic stem cell transplant recipients]. Med Clin (Barc) 1998;111(1):19- 22. 8. Yakushijin Y, Minamoto Y, Takada K, Otsuka M, Yasu- kawa M, Fujita S. A case of fatal varicella zoster infec- tion with refractory abdominal pain as an early symp- tom. Kansenshogaku Zasshi 2004;78(1):64-69. 9. Kim MK, Strait RT, Sato TT, Hennes HM. A randomized clinical trial of analgesia in children with acute abdomi- nal pain. Acad Emerg Med 2002;9(4):281-287. 10. McHale PM, LoVecchio F. Narcotic analgesia in the acute abdomen--a review of prospective trials. Eur J Emerg Med 2001;8(2):131-136. 11. Rogers SY, Irving W, Harris A, Russell NH. Visceral varicella zoster infection after bone marrow transplanta- tion without skin involvement and the use of PCR for di- agnosis. Bone Marrow Transplant 1995;15(5):805-807. 248 Articles © The authors, Journal compilation © J Clin Med Res and Elmer Press™, www.jocmr.org