Cases reported "Exanthema"

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1/14. Acute abdomen without cutaneous signs of varicella zoster virus infection as a late complication of allogeneic bone marrow transplantation: importance of empiric therapy with acyclovir.

    Two patients complained of severe abdominal pain as the first sign of varicella zoster virus infection about 1 year after allogeneic BMT. In case 1, eruptions, found on the face and chest on admission, became vesicular and dispersed on the third hospital day. Though acyclovir (ACV) was immediately started, he died on the fourth day. In case 2, skin rash was never observed during the clinical course. laparotomy on the third hospital day revealed many hemorrhagic spots on the liver surface and mucous membrane of the upper GI tract, indicating disseminated visceral disease. Empiric therapy with ACV was successful.
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ranking = 1
keywords = varicella
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2/14. Varicella followed by glomerulonephritis. Treatment with corticosteroids and azathioprine resulting in recurrence of varicella.

    The present report outlines the clinical features of a 2-year-old boy who following varicella developed purpura of the lower extremities, transient gastrointestinal bleeding and glomerulonephritis. The triad of symptoms suggests Schonlein-Henoch Syndrome, but coagulation studies and renal biopsy did not confirm this, and varicella is thought to be the cause of the complications. Therapy with corticosteroids and azathioprine had only a minor effect on the nephritis but caused depression of serum IgG and specific antibody resulting in reinfection or reactivation of varicella.
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ranking = 1.4
keywords = varicella
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3/14. Congenital skin lesions caused by intrauterine infection with coxsackievirus B3.

    BACKGROUND: Serious neonatal coxsackievirus infections transplacentally acquired in late pregnancy involve primarily the central nervous system, heart, liver and rarely the skin. patients AND methods: A boy born with a disseminated papulovesicular, nodular, bullous and necrotic ulcerated rash at 39 weeks gestational age developed pneumonia, carditis and hepatitis during the first days after birth. Molecular biological and serological methods were used for virological diagnosis. RESULTS: Coxsackievirus B3 (CVB3) was found in throat swabs and/or feces of the neonate and his mother. In addition, there was serological evidence of intrauterine infection. CONCLUSION: Intrauterine transmission of CVB3 during late pregnancy may lead to varicella-like congenital skin lesions.
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ranking = 0.2
keywords = varicella
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4/14. Chronic varicella-zoster virus ganglionitis--a possible cause of postherpetic neuralgia.

    Postherpetic neuralgia (PHN) is dermatomal distribution pain that persists for months to years after the resolution of herpes zoster rash. The cause of PHN is unknown. Herein, we report clinical, molecular virological, and immunological findings over an 11-year period in an immunocompetent elderly woman with PHN. Initially, blood mononuclear cells (MNCs) contained varicella-zoster virus (VZV) dna on two consecutive occasions. Random testing after treatment with famciclovir to relieve pain did not detect VZV dna. However, the patient was reluctant to continue famciclovir indefinitely and voluntarily stopped drug treatment five times. Pain always recurred within 1 week, and blood MNCs contained many, but not all, regions of the VZV genome on all five occasions. Immunological analysis revealed increased cell-mediated immunity to VZV. Chronic VZV ganglionitis-induced PHN best explains the recurrence of VZV dna in MNCs whenever famciclovir was discontinued; the detection of only some regions of the viral genome in MNCs, compared to the detection of all regions of the VZV genome in latently infected ganglia; the increased cell-mediated immunity to VZV; and a gratifying clinical response to famciclovir. The presence of fragments of VZV dna in MNCs likely represents partial degradation of viral dna in MNCs that trafficked through ganglia during productive infection.
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ranking = 1
keywords = varicella
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5/14. Varicella infection in a pediatric AIDS patient presenting as umbilicated papules.

    An 8-year-old girl with acquired immunodeficiency syndrome presented with fever and alteration of consciousness. She had a history of persistent cryptococcal meningitis. She developed multiple discrete umbilicated papules that resembled cutaneous cryptococcosis on the second day of admission. skin biopsy revealed an ulcer with a wedge-shaped necrosis of the dermis. The edge of the ulcer showed intracellular edema, margination of nucleoplasm and multinucleated cells, consistent with herpes infection. The diagnosis of varicella-zoster virus infection was confirmed by the identification of herpesvirus dna from the lesion and differentiation from other herpesviruses by restriction fragment length polymorphism (RFLP) method. Intravenous acyclovir was given at a dose of 500 mg/m2, three times daily for 14 days which resulted in resolution of the skin lesions within 2 weeks.
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ranking = 0.2
keywords = varicella
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6/14. skin rash and splinter hemorrhages from ganciclovir.

    ganciclovir is a nucleotide-analogue similar to acyclovir, which has an in vitro activity against herpes simplex type 1, herpes simplex type 2 and varicella zoster virus. Numerous studies suggest that ganciclovir has clinical efficacy against cytomegalovirus disease, as well as an in vivo antiviral effect, and that this agent reduces morbidity of serious cytomegalovirus infections in immunocompromised patients. Generalised cutaneous rash associated with ganciclovir therapy has rarely been reported in literature.
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ranking = 0.2
keywords = varicella
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7/14. Multifocal varicella-zoster virus vasculopathy without rash.

    A 51-year-old woman with crest syndrome (calcinosis, Raynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia) developed stepwise progressive focal neurological deficits without zoster rash. Multifocal ischemic infarcts were seen on magnetic resonance imaging, and cerebral angiography revealed focal stenosis of arteries affecting the intracranial circulation. A brain biopsy was nondiagnostic. Virological etiology of the disease was verified by the detection of varicella-zoster virus antibody in cerebrospinal fluid and by reduced serum-cerebrospinal fluid varicella-zoster virus IgG ratios (compared with normally high ratios of total IgG and albumin). Treatment with intravenous acyclovir stabilized but did not significantly improve her neurological deficits.
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ranking = 1.2
keywords = varicella
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8/14. Infectious disease capsules: a pox on your house.

    A 31-year-old, previously healthy white man presented to the emergency department with complaints of malaise, fevers, shortness of breath, a non-productive cough, and a "rash." His physical exam revealed a temperature of 100.2F, a pulse of 129 bpm, respiratory rate of 14 BPM, and blood pressure of 140/74 mm Hg. He was alert, oriented, and in no distress. His oropharynx was dry, his neck was supple, and cervical lymphadenopathy was absent. He had tachycardia, bilateral wheezes, and rhonchi with prolonged expirations. There was a diffuse vesicular eruption enveloping his entire body with involvement sparing his palms and soles (Figures 1 and 2). Laboratory values showed a hemoglobin of 16.0 g/dL and a white blood cell count of 7100 cells/pL, with 39%neutrophils, 23% bands, and 35% lymphocytes. His platelet count was mildly decreased to 86,000 x 103/pL. Chest radiograph revealed bilateral diffuse interstitial infiltrates. A diagnosis of acute varicella-zoster virus pneumonia (varicella pneumonia) was made, and the patient was started on IV acyclovir (10 mg/kg every 8 hours). Upon further questioning, the patient stated that his daughter had been diagnosed with "chickenpox" 7 days ago. The patient had numerous exposures to chickenpox in the past but had never developed clinical expressions of varicella. He was not at risk for hiv infection, not having multiple sexual partners, IV drug abuse, or blood transfusions. During the 1 day of in-hospitalization, his fever abated and the pulmonary signs diminished.Following discharge, IV acyclovir was replaced by valacyclovir to complete a 7-day course of therapy.
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ranking = 4.770449151221
keywords = chickenpox, varicella
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9/14. Kawasaki disease associated with chickenpox: report of two sibling cases.

    Kawasaki disease is a group of acute febrile illnesses of young children. Infectious etiology for Kawasaki disease has been long postulated, although no single causing agent has been identified consistently by conventional methods. This report described two sisters, soon after a primary infection by varicella-zoster virus, manifesting fever and muco-cutaneous lesions compatible with the feature of Kawasaki disease consecutively. Mild dilatation of the coronary artery was revealed in both by echocardiography. Both of them received intravenous gamma-globulin therapy and the follow-up echocardiography showed no further progression of the coronary lesion. We suggest the possibility of varicella-zoster virus as one of the triggering agents for Kawasaki disease in genetically susceptible individuals. The severe cardiac complication of Kawasaki disease may be prevented by early treatment if clinicians are alert to this possible association in those children with chickenpox exhibiting unusual muco-cutaneous lesions.
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ranking = 10.826122878053
keywords = chickenpox, varicella
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10/14. Varicella-associated arthritis occurring before the exanthem. Case report and literature review.

    Varicella-associated arthritis represents an uncommon complication of varicella in children. In 20 previously reported cases, three were documented to be bacterial in origin. Viral isolation from synovial fluid was attempted in seven others, and varicella was isolated in just two. In all previous case reports, the arthritis occurred after or coincident with the onset of varicella. The current case is one in which joint involvement preceded the clinical onset of varicella. Clinicians should be alert to the possibility that varicella may manifest as an acute arthritis, even in the absence of the typical exanthem.
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ranking = 1
keywords = varicella
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