Hemorrhagic shock resulting from varicella zoster (VZ) gastr
The present case appears in the International Journal of Infectious Diseases.

Case Highlights
• The case of a patient with varicella zoster gastritis complicated with severe upper gastrointestinal bleeding and hemorrhagic shock is reported

• Gastric manifestations of varicella zoster infections in non-immunocompromised patients have been scarcely described

• A high clinical index of suspicion with prompt treatment is needed because of the severity of varicella zoster gastritis

An 82-year-old woman was admitted to ICU with hemorrhagic shock due to a severe upper gastrointestinal bleeding. Her medical history was unremarkable except for an old breast cancer. One week before, she had developed papulovesicular eruptions of the face, trunk and extremities, together with abdominal pain and vomiting. She had been diagnosed with varicella with gastrointestinal involvement.

After initial resuscitation, requiring fluid infusion, massive blood transfusion, high dose vasopressors and mechanical ventilation, an emergency esophagogastroduodenoscopy was performed and revealed a large blood clot covering the entire gastric area, together with an active bleeding, which were treated by local epinephrine injection.

The cause of bleeding was not identified and gastric biopsies were not obtainable. A follow-up endoscopy performed 24 hours later showed multiple small erosions and ulcerations, with slightly raised erythematous margins, involving the greater tuberosity. The patient declared she had not previously been infected with VZV.

VZV-IgG antibodies were detectable in serum specimens and qualitative VZV polymerase chain reaction was positive. A diagnosis of varicella zoster gastritis was retained. Antiviral therapy with Aciclovir was started. By day 10 after admission, our patient had fully recovered and was transferred to the medical ward.

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