The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, 510317, China.
Guangdong clinical college of dermatology, Anhui medical university, Guangzhou, 510000, China.
BMC Infect Dis. 2024 Jul 11;24(1):691. doi: 10.1186/s12879-024-09383-0.
Hemorrhagic varicella (HV) is a particular form of chicken pox.,with high mortality in adults. This form of the disease is rare, to date, approximately 4 cases have been reported. Occasional cases of HV have been documented in adults with hematologic disorders or other diseases. While there is one reported case of simultaneous reactivation of cytomegalovirus in an adult with chickenpox, there is a lack of information regarding changes in liver function indicators for such patients. This is unfortunate, as CMV reactivation can further exacerbate liver failure and increase mortality. In this report, we present a case of hemorrhagic varicella reactivation with cytomegalovirus and provide some relevant discussions.
We present the case of a 25-year-old male with HV, who had a history of nephrotic syndrome generally controlled with orally administered prednisone at a dosage of 50 mg per day for two months. The patient arrived at the emergency room with complaints of abdominal pain and the presence of hemorrhagic vesicles on his body for the past 3 days. Despite medical evaluation, a clear diagnosis was not immediately determined. Upon admission, the leukocyte count was recorded as 20.96 × 10/L on the first day, leading to the initiation of broad-spectrum antibiotic treatment. Despite the general interpretation that a positive IgG and a negative IgM indicate a previous infection, the patient's extraordinarily elevated IgG levels, coupled with a markedly increased CMV DNA quantification, prompted us to suspect a reactivation of the CMV virus. In light of these findings, we opted for the intravenous administration of ganciclovir as part of the treatment strategy. Unfortunately,,the patient succumbed to rapidly worsening symptoms and passed away. Within one week of the patient's demise, chickenpox gradually developed in the medical staff who had been in contact with him. In such instances, we speculate that the patient's diagnosis should be classified as a rare case of hemorrhagic varicella.
Swift identification and timely administration of suitable treatment for adult HV are imperative to enhance prognosis.
出血性水痘（HV）是一种特殊形式的水痘，成人死亡率高。这种疾病形式很少见，迄今为止，大约报告了 4 例。在患有血液系统疾病或其他疾病的成年人中偶尔有 HV 病例的记录。虽然有一例成人水痘同时再激活巨细胞病毒的报道，但对于此类患者的肝功能指标变化的信息却很少。这很不幸，因为 CMV 再激活会进一步加重肝衰竭并增加死亡率。在本报告中，我们报告了一例伴有巨细胞病毒的出血性水痘再激活病例，并进行了一些相关讨论。
我们报告了一例 25 岁男性 HV 病例，他患有肾病综合征，通常每天口服泼尼松 50mg 控制病情，持续两个月。患者因腹痛和 3 天前全身出现出血性水疱到急诊室就诊。尽管进行了医学评估，但未能立即明确诊断。入院时，白细胞计数第一天记录为 20.96×10/L，导致开始广谱抗生素治疗。尽管一般解释是 IgG 阳性和 IgM 阴性表明既往感染，但患者异常高的 IgG 水平，加上 CMV DNA 定量明显增加，促使我们怀疑 CMV 病毒再激活。鉴于这些发现，我们选择静脉注射更昔洛韦作为治疗策略的一部分。不幸的是，患者因症状迅速恶化而死亡。在与患者接触的医务人员中，在患者死亡后的一周内逐渐出现水痘。在这种情况下，我们推测患者的诊断应归类为罕见的出血性水痘病例。
迅速识别和及时给予成人 HV 适当的治疗对改善预后至关重要。
