Takada Hiroaki, Kohara Saeko, Ito Takashi, Yoshioka Hayato, Okada Ichiro, Kiriu Nobuaki, Koido Yuichi, Hasegawa Eijyu
Department of Critical Care Medicine and Trauma National Hospital Organization Disaster Medical Center Tokyo Japan.
Acute Med Surg. 2020 Mar 6;7(1):e494. doi: 10.1002/ams2.494. eCollection 2020 Jan-Dec.
Disseminated Varicella zoster virus infection (DVI) is a severe infection associated with severe abdominal pain of unknown cause. We report a case in which periarterial (the celiac artery and superior mesenteric artery) fat stranding (PFS) on computed tomography (CT) was the presumed cause of abdominal pain in a patient taking pomalidomide.
A 62-year-old woman was admitted to our hospital with abdominal pain. Her medical history was multiple myeloma treated with pomalidomide. Computed tomography showed no remarkable findings on admission, but 1 day later, a contrast-enhanced CT showed PFS. A skin eruption appeared on day 4 and we started acyclovir. On day 10, Varicella zoster virus antigen and antibody tests were positive, confirming the diagnosis of DVI. The abdominal pain subsequently improved, together with the PFS, and she was discharged.
When patients present with severe abdominal pain and PFS, DVI and acyclovir must be considered.
播散性水痘带状疱疹病毒感染（DVI）是一种严重感染，伴有原因不明的严重腹痛。我们报告一例服用泊马度胺的患者，计算机断层扫描（CT）显示腹腔动脉周围（腹腔干和肠系膜上动脉）脂肪密度增高（PFS）被推测为腹痛原因。
一名62岁女性因腹痛入院。她的病史为接受泊马度胺治疗的多发性骨髓瘤。入院时CT未发现明显异常，但1天后，增强CT显示PFS。第4天出现皮疹，我们开始使用阿昔洛韦。第10天，水痘带状疱疹病毒抗原和抗体检测呈阳性，确诊为DVI。随后腹痛与PFS一同改善，患者出院。
当患者出现严重腹痛和PFS时，必须考虑DVI并使用阿昔洛韦治疗。
