Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Herpes zoster complicated by deep vein thrombosis: a case report

대상포진에 합병된 심부정맥혈전증 1예

  • Choi, Woo-Yeon (Department of Pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Cho, Young-Kuk (Department of Pediatrics, Chonnam National University Medical School Chonnam National University Hospital) ;
  • Ma, Jae-Sook (Department of Pediatrics, Chonnam National University Medical School Chonnam National University Hospital)
  • 최우연 (전남대학교의과대학, 전남대학교병원 소아과학교실) ;
  • 조영국 (전남대학교의과대학, 전남대학교병원 소아과학교실) ;
  • 마재숙 (전남대학교의과대학, 전남대학교병원 소아과학교실)
  • Received : 2008.09.19
  • Accepted : 2009.02.06
  • Published : 2009.05.15
Download PDF
⟨ Previous Next ⟩

Abstract

Varicella zoster virus (VZV) causes two diseases: Varicella, a generalized, primary infection, and herpes zoster (zoster), a secondary infection caused by latent VZV reactivation. Zoster can also be caused by latent VZV reactivation after a varicella vaccination. The complications associated with varicella include cutaneous infections, which are the most common, as well as pulmonary and neurological involvement. However, a deep venous thrombosis (DVT) has been rarely described as a varicella-associated complication. Here, we describe the case of a child with varicella zoster who developed a DVT that completely resolved after intravenous acyclovir and subcutaneous low-molecular-weight heparin treatment.

수두 바이러스는 두 가지 임상 증후군을 유발하는 데, 초회 감염되면 수두를, 지각 신경절에 잠복해 있다가 재발하면 대상포진을 일으킨다. 수두백신이 널리 이용되면서 수두 이후의 대상포진 뿐만 아니라 수두백신 접종 후 발생한 대상포진도 관찰되고 있다. 수두바이러스에 의한 합병증으로는 2차 세균감염에 의한 농가진, 연조직염 등의 피부감염이 가장 흔하며 이외에도 호흡기계와 신경계의 합병증이 잘 알려져 있다. 또 수두 바이러스 감염 후의 합병증으로 심부정맥혈전증이 매우 드물게 보고되고 있다. 주로 혈관벽의 손상과 관련된 것으로 여겨지며 하지 정맥을 침범한다. 수두 감염된 심부정맥혈전증 증상을 보이는 환자에서 합병증을 의심하고 조기 진단하여 항응고치료를 하는 것이 추천된다. 이에 저자들은 수두 백신만 1회 접종한 환아에서 심부정맥혈전증을 동반한 대상포진이 발생하여 acyclovir 정맥주사와 저분자량 헤파린 피하주사로 회복되어 보고한다.

Keywords

References

  1. Leung AK, Robson WL, Leong AG. Herpes zoster in childhood. J Pediatr Health Care 2006;20:300-3 https://doi.org/10.1016/j.pedhc.2006.01.004
  2. Arvin AM. Varicella-zoster virus. Clin Microbiol Rev 1996; 9:361-81
  3. Hope-Simpson RE. The nature of herpes zoster: a long-term study and a new hypothesis. Proc R Sco Med 1965;58:9-20
  4. Katsushima N, Yazaki N, Sakamoto M. Effect and follow- up study on varicella vaccine. Biken J 1984;27:51-7
  5. Lawrence R, Gershon AA, Holzman R, Steinberg SP. The risk of zoster after varicella vaccination in children with leukemia. N Engl J Med 1988;318:543-8 https://doi.org/10.1056/NEJM198803033180904
  6. Hammerschlag MR, Gershon AA, Steinberg SP, Clarke L, Gelb LD. Herpes zoster in an adult recipient of live attenuated varicella vaccine. J Infect Dis 1989;160:535-7 https://doi.org/10.1093/infdis/160.3.535
  7. Johnson C, Rome LP, Stancin T, Kumar ML. Humoral immunity and clinical reinfections following varicella vaccine in healthy children. Pediatrics 1989;84:418-21
  8. Arbeter AM, Starr SE, Plotkin SA. Varicella vaccine studies in healthy children and adults. Pediatrics 1986;78:748-56
  9. Schmidt NJ, Arvin AM. Sensitivity of different assay systems for immunoglobulin M responses to varicella-zoster virus in reactivated infections (zoster). J Clin Microbiol 1986; 23:978-9
  10. Gershon AA, Steinberg SP, Borkowsky W, Lennette D, Lennette E. IgM to varicella-zoster virus: demonstration in patients with and without clinical zoster. Pediatr Infect Dis 1982;1:164-7 https://doi.org/10.1097/00006454-198205000-00007
  11. Gelb LD, Dohner DE, Gershon AA, Steinberg SP, Waner JL, Takahashi M, et al. Molecular epidemiology of live, attenuated varicella virus vaccine in children with leukemia and in normal adults. J Infect Dis 1987;155:633-40 https://doi.org/10.1093/infdis/155.4.633
  12. Takada M, Suzstani T, Yoshida I, matoba M, Azuma M. Identification of varicella zoster virus strains by PCR analysis of three repeat elements and a PstI-site-less region. J Clin Microbiol 1995:33;658-60
  13. di Luzio Paparatti U, Arpinelli F, Vison$\grave{a}$ G. Herpes zoster and its complications in Italy: an observational survey. J Infect 1999;38:116-20 https://doi.org/10.1016/S0163-4453(99)90079-8
  14. Ali MS, Kutty MS, Corea JR, Kutty K. Iliofemoral thrombosis in a case of chicken pox. Angiography 1984;35:577-8
  15. Gogos CA, Apostolidou E, Bassaris HP, Vagenakis AG. Three cases of varicella thrombophlebitis as a complication of varicella zoster virus infection. Eur J Clin Microbiol Infect Dis 1993;12:43-5 https://doi.org/10.1007/BF01997056
  16. Bodensteiner JB,Hille MR,Riggs JE. Clinical features of vascular thrombosis following varicella. Am J Dis Child 1992;146:100-2
  17. Minick CR, Fabricant CG, Fabricant J, Litrenta MM. Athero-arteriosclerosis induced by infection with a herpesvirus. Am J Pathol 1979;96:673-706
  18. Gunby P. Viral infection may lead to vessel wall problems. J Am Med Assoc 1984;251:1131-2 https://doi.org/10.1001/jama.251.9.1131
  19. Johnson HN. Visceral lesions associated with varicella. Archives of Pathology 1940;30:292-307
  20. Sargent EN, Carson MJ, Reilly ED. Roentgenographic manifestations of varicella pneumonia with postmortem correlation. Am J Roentgenol Radium Ther Nucl Med 1966;98:305- 17