Case Report Elmer Press J Clin Med Res • 2009;1(4):247-248 Varicella Zoster Infection: A Rare Cause of Abdominal Pain Mimicking Acute Abdomen Deniz Olmeza, Alper Bozb, Nazif Erkanb, c Abstract Varicella zoster is an acute viral infection that results from re- activation 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 Introduction Varicella zoster is an acute viral infection that results from reactivation of a latent varicella zoster virus. The goal of intervention is to reduce associated pain and discomfort. A prompt diagnosis and appropriate management occur with greater frequency in the adult population. It rarely oc- curs in otherwise normal children [1]. Varicella zoster virus is known to cause varicella in children and reactivate years later as shingles. Varicella zoster infection usually is a minor illness, but can result in serious life threatening complica- tions in previously healthy patients. Frequent complications include bacterial skin infections, pneumonitis, complications affecting the central nervous system and hepatitis [2, 3]. It sometimes mimics acute abdomen especially before the ap- pearance of skin rashes [4-8]. In general surgery clinics, var- icella zoster cases are rarely described. In this study, we pres- ent an atypical case of varicella zoster with abdominal pain Manuscript accepted for publication August 18, 2009 aIzmir Bozyaka Training and Research Hospital, Department of Anaes- thesiology, Bozyaka, Izmir, Turkey bIzmir Bozyaka Training and Research Hospital, Department of Sur- gery, Bozyaka, Izmir, Turkey cCorresponding author: naziferkan@gmail.com doi:10.4021/jocmr2009.09.1259 mimicking acute abdomen, and also the literature review. Case Report A 14-year-old male child had been admitted to emer- gency department of our hospital. He was suffering from a severe, generalized abdominal pain. He had nausea and vom- iting accompanying abdominal pain. The patient could not identify a location on his abdomen where the pain was most severe. On physical examination, there was abdominal rigid- ity, muscle guarding and rebound tenderness. Laboratory tests were non specific. Chest x-ray, abdominal ultrasonog- raphy and computerized tomography were normal. We sus- pected peritonitis. During the two days of follow-up period, the abdominal pain was localized on the left lower quadrant. So, we thought it could be an intestinal tractus disease such as diverticulitis, regional enteritis, etc. No analgesics were given for pain due to suspicion of acute abdomen. In control abdominal ultrasonography, any emergent pathology was not found and the intensity of abdominal pain was decreased. Then the patient was discharged home. In control period, he returned demonstrating the maculopapular lesions of skin over left inguinal region 4 days later. The patient was ex- amined by a dermatologist and it was diagnosed as varicella zoster. Varicella zoster was not diagnosed until he developed a maculopapular rash over left inguinal region 1 week after the onset of pain. Acyclovir was given orally and pomad was applied over the skin lesions. The patient’s abdominal pain resolved over a few days. Discussion Varicella zoster results from reactivation of the varicel- la-zoster virus in cells of the dorsal root ganglia after chick- enpox. The skin lesions begin as a maculopapular rash that follows a dermatomal distribution. In the absence of cutane- ous eruption, visceral zoster is difficult to diagnose [7]. The severe pain of visceral zoster has long been recog- nized. Visceral pain from herpes zoster can be misdiagnosed as an ‘acute abdomen’ leading to unnecessary surgical explo- Articles © The authors, Journal compilation © J Clin Med Res and Elmer Press™, www.jocmr.org 247