- Email: [email protected]
Chickenpox Oesophagitis and Haematemesis in an Immunocompetent Adult
206
Letters to the Editor
2 Gortvai P, De Louvois J, Hurley R. The bacteriology and chemotherapy of acute pyogenic brain abscess. Br J Neurosurg 1987; 1(2): 189±203. 3 Britt RH, Enzmann DR, Remington JS. Intracranial infection in cardiac transplant recipients. Ann Neurol 1981; 9(2): 107±119. 4 Beller AJ, Sahar A, Praiss I. Brain abscess. Review of 89 cases over a period of 30 years. J Neurol, Neurosurg Psychiat 1973; 36(5): 757±768. 5 Krajewski R, Stelmasiak Z. Brain abscess in infants. Childs Nerv Syst 1992; 8(5): 279±280. 6 Basu S, Mukherjee KK, Poddar B, Goraya JS, Chawla K, Parmar VR. An unusual case of neonatal brain abscess following Klebsiella pneumoniae septicemia. Infection 2001; 29(5): 283±285. 7 Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Archiv Internal Med 1991; 151(8): 1557±1559. 8 Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wann SR et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis 1998; 26(6): 1434±1438. 9 Miyagishima T, Ishizaka F, Hirano T, Kurokawa Y, Kunieda Y, Hige S et al. [A case of Klebsiella bacteremia with brain, lung, and liver and skin abscesses]. Nippon Naika Gakkai Zasshi ± J Jpn Soc Internal Med 1988; 77(3): 404±408. 10 Liliang PC, Hung KS, Cheng CH, Chen HJ, Ohta I, Lui CC. Rapid gas-forming brain abscess due to Klebsiella pneumoniae. Case illustration. J Neurosurg 1999; 91(6): 1060. 11 Hughes KB, Simon J. Intracranial infection complicating chronic ear disease. J Roy Army Med Corps 1983; 129(1): 50±51. 12 Nagase T, Wada S, Nakamura R, Morisako T, Kamakura K, Kugai N et al. Magnetic resonance imaging of multiple brain abscesses of the bilateral basal ganglia. Internal Med 1995; 34(6): 554±558. Accepted for publication 18 December 2001.
doi:10.1053/jinf.2002.0958, available online at http://www.idealibrary.com on
children. He had no risk factors or evidence of immunodeficiency. Two days after the onset of the typical cutaneous lesions, he developed painful ulceration of the mouth and low retrosternal and epigastric pain that was accompanied by odynophagia. He was admitted to hospital with recurrent minor haematemesis. On examination, multiple small ulcers in the oropharynx were visible in addition to the cutaneous chickenpox lesions. Subsequent endoscopic examination revealed multiple, small (1±3 mm in diameter), focal ulcers from 23 to 36 cm of the oesophageal mucosa. The gastric and duodenal mucosae, however, were normal. There was no evidence of other visceral involvement with VZV in this patient. Following conservative management with oral aciclovir and omeprazole, he recovered fully without further complication. This case indicates that ulcerative VZV oesophagitis may complicate chickenpox in an immunocompetent individual, confirming previous speculation [6]. Furthermore, this case indicates that VZV oesophagitis may occur as an isolated complication of chickenpox in the absence of severe disseminated disease.
Stephen D. Lawn*, Pradhib Venkatesan
Department of Medicine, Infectious Diseases Unit, Nottingham City Hospital NHS Trust, Nottingham, U.K.
*Corresponding author. Hospital for Tropical Diseases, Mortimer Market, Capper Street off Tottenham Court Road, London WC1E 6AU, U.K. Tel.: +207-387-9300; Fax: +20-7380-9761. E-mail address: [email protected]
Chickenpox Oesophagitis and Haematemesis in an Immunocompetent Adult Sir, Oesophageal infections with herpesviruses, including herpes simplex virus (HSV) and cytomegalovirus (CMV), are underdiagnosed complications of a variety of conditions, including malignancy, human immunodeficiency virus type 1 infection and other illnesses associated with generalized debility and immunodeficiency [1±4]. However, compared to HSV and CMV, varicella±zoster virus (VZV) is reported to be a very rare cause of oesophagitis, occurring only among extremely debilitated patients [1] and presumably resulting from reactivation of latent viral infection. Nevertheless, it is possible that oesophagitis may also complicate primary VZV infection (chickenpox); virus-induced oesophagitis was found at autopsy of a patient who died of severe, disseminated chickenpox [5] and a case has also been reported in whom this condition was clinically suspected, but was unconfirmed [6]. We report the case of a 31-year-old male who developed chickenpox following exposure to the disease in his two
References 1 Baerhr B, McDonald GB. Esophageal infections: risk factors, presentation, diagnosis and treatment. Gastroenterology 1994; 106: 509± 532. 2 Buss DH, Scharyj M. Herpesvirus infection of the esophagus and other visceral organs in adults. Am J Med 1979; 66: 457±462. 3 Rosen P, Hajdu SI. Visceral herpesvirus infections in patients with cancer. Am J Clin Pathol 1971; 56: 459. 4 Smith PD, Eisner MS, Manischewitz JF, Gill VJ, Masur H, Fox CF. Esophageal disease in AIDS is associated with pathologic processes rather than mucosal human immunodeficiency virus type 1. J Infect Dis 1993; 167: 547±552. 5 Sherman RA, Silva Jr. J, Gandour-Edwards R. Fatal Varicella in an adult: case report and review of the gastrointestinal complications of chickenpox. Rev Infect Dis 1991; 13: 424±427. 6 Bardhan KD. Cimetidine in ``chickenpox oesophagitis''. Br Med J 1978; 6109: 858. Accepted for publication 18 December 2001.
Letters to the Editor
2 Gortvai P, De Louvois J, Hurley R. The bacteriology and chemotherapy of acute pyogenic brain abscess. Br J Neurosurg 1987; 1(2): 189±203. 3 Britt RH, Enzmann DR, Remington JS. Intracranial infection in cardiac transplant recipients. Ann Neurol 1981; 9(2): 107±119. 4 Beller AJ, Sahar A, Praiss I. Brain abscess. Review of 89 cases over a period of 30 years. J Neurol, Neurosurg Psychiat 1973; 36(5): 757±768. 5 Krajewski R, Stelmasiak Z. Brain abscess in infants. Childs Nerv Syst 1992; 8(5): 279±280. 6 Basu S, Mukherjee KK, Poddar B, Goraya JS, Chawla K, Parmar VR. An unusual case of neonatal brain abscess following Klebsiella pneumoniae septicemia. Infection 2001; 29(5): 283±285. 7 Cheng DL, Liu YC, Yen MY, Liu CY, Wang RS. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Archiv Internal Med 1991; 151(8): 1557±1559. 8 Wang JH, Liu YC, Lee SS, Yen MY, Chen YS, Wann SR et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis 1998; 26(6): 1434±1438. 9 Miyagishima T, Ishizaka F, Hirano T, Kurokawa Y, Kunieda Y, Hige S et al. [A case of Klebsiella bacteremia with brain, lung, and liver and skin abscesses]. Nippon Naika Gakkai Zasshi ± J Jpn Soc Internal Med 1988; 77(3): 404±408. 10 Liliang PC, Hung KS, Cheng CH, Chen HJ, Ohta I, Lui CC. Rapid gas-forming brain abscess due to Klebsiella pneumoniae. Case illustration. J Neurosurg 1999; 91(6): 1060. 11 Hughes KB, Simon J. Intracranial infection complicating chronic ear disease. J Roy Army Med Corps 1983; 129(1): 50±51. 12 Nagase T, Wada S, Nakamura R, Morisako T, Kamakura K, Kugai N et al. Magnetic resonance imaging of multiple brain abscesses of the bilateral basal ganglia. Internal Med 1995; 34(6): 554±558. Accepted for publication 18 December 2001.
doi:10.1053/jinf.2002.0958, available online at http://www.idealibrary.com on
children. He had no risk factors or evidence of immunodeficiency. Two days after the onset of the typical cutaneous lesions, he developed painful ulceration of the mouth and low retrosternal and epigastric pain that was accompanied by odynophagia. He was admitted to hospital with recurrent minor haematemesis. On examination, multiple small ulcers in the oropharynx were visible in addition to the cutaneous chickenpox lesions. Subsequent endoscopic examination revealed multiple, small (1±3 mm in diameter), focal ulcers from 23 to 36 cm of the oesophageal mucosa. The gastric and duodenal mucosae, however, were normal. There was no evidence of other visceral involvement with VZV in this patient. Following conservative management with oral aciclovir and omeprazole, he recovered fully without further complication. This case indicates that ulcerative VZV oesophagitis may complicate chickenpox in an immunocompetent individual, confirming previous speculation [6]. Furthermore, this case indicates that VZV oesophagitis may occur as an isolated complication of chickenpox in the absence of severe disseminated disease.
Stephen D. Lawn*, Pradhib Venkatesan
Department of Medicine, Infectious Diseases Unit, Nottingham City Hospital NHS Trust, Nottingham, U.K.
*Corresponding author. Hospital for Tropical Diseases, Mortimer Market, Capper Street off Tottenham Court Road, London WC1E 6AU, U.K. Tel.: +207-387-9300; Fax: +20-7380-9761. E-mail address: [email protected]
Chickenpox Oesophagitis and Haematemesis in an Immunocompetent Adult Sir, Oesophageal infections with herpesviruses, including herpes simplex virus (HSV) and cytomegalovirus (CMV), are underdiagnosed complications of a variety of conditions, including malignancy, human immunodeficiency virus type 1 infection and other illnesses associated with generalized debility and immunodeficiency [1±4]. However, compared to HSV and CMV, varicella±zoster virus (VZV) is reported to be a very rare cause of oesophagitis, occurring only among extremely debilitated patients [1] and presumably resulting from reactivation of latent viral infection. Nevertheless, it is possible that oesophagitis may also complicate primary VZV infection (chickenpox); virus-induced oesophagitis was found at autopsy of a patient who died of severe, disseminated chickenpox [5] and a case has also been reported in whom this condition was clinically suspected, but was unconfirmed [6]. We report the case of a 31-year-old male who developed chickenpox following exposure to the disease in his two
References 1 Baerhr B, McDonald GB. Esophageal infections: risk factors, presentation, diagnosis and treatment. Gastroenterology 1994; 106: 509± 532. 2 Buss DH, Scharyj M. Herpesvirus infection of the esophagus and other visceral organs in adults. Am J Med 1979; 66: 457±462. 3 Rosen P, Hajdu SI. Visceral herpesvirus infections in patients with cancer. Am J Clin Pathol 1971; 56: 459. 4 Smith PD, Eisner MS, Manischewitz JF, Gill VJ, Masur H, Fox CF. Esophageal disease in AIDS is associated with pathologic processes rather than mucosal human immunodeficiency virus type 1. J Infect Dis 1993; 167: 547±552. 5 Sherman RA, Silva Jr. J, Gandour-Edwards R. Fatal Varicella in an adult: case report and review of the gastrointestinal complications of chickenpox. Rev Infect Dis 1991; 13: 424±427. 6 Bardhan KD. Cimetidine in ``chickenpox oesophagitis''. Br Med J 1978; 6109: 858. Accepted for publication 18 December 2001.