Systemic lupus erythematosus with visceral varicella: A case report

Abstract

BACKGROUND

As an autoimmune disease, systemic lupus erythaematosus (SLE) can affect multiple systems of the body and is mainly treated by steroids and immunosuppressive agents. SLE results in a long-term immunocompromised state with the potential of infection complications (e.g., bacterial, fungal and viral infections). Abdominal pain or acute abdomen are frequently the only manifestations of SLE at disease onset or during the early stage of the disease course. Thus, multidisciplinary collaboration is required to identify these patients because timely diagnosis and treatment are crucial for improving their prognosis.

CASE SUMMARY

Herein, we reported a case of an SLE patient with visceral varicella that was identified after the onset of abdominal pain. The 16-year-old female patient with SLE was admitted to our hospital due to initial attacks of abdominal pain and intermittent fever. The patient’s condition rapidly became aggravated within a short time after admission, with large areas of vesicular rash, severe pneumonia, respiratory failure, shock, and haematologic system and hepatic function impairment. Based on multidisciplinary collaboration, the patient was diagnosed with visceral disseminated varicella and was administered life support, antiviral (acyclovir), immunomodulatory (intravenous injection of human immunoglobulin), anti-infection (vancomycin) and anti-inflammatory (steroid) therapies. After treatment, her clinical symptoms and laboratory indicators gradually improved, and the patient was discharged.

CONCLUSION

SLE patients long treated with steroids and immunosuppressive agents are susceptible to various infections. Considering that visceral varicella with abdominal pain as the initial presentation is characterized by rapid progression and often coexists with serious complications, prompt diagnosis and early antiviral therapy are critical to prevent severe life-threatening complications.

Keywords: Systemic lupus erythematosus; Visceral varicella; Severe pneumonia; Tacrolimus; Mycophenolate mofetil; Case report

Core Tip: The long-term use of steroids and immunosuppressive agents for the treatment of systemic lupus erythaematosus may decrease immunity, which is a high-risk factor for varicella-zoster virus (VZV) infection and severe varicella. Patients with varicella who suddenly develop abdominal pain should be informed about visceral disseminated VZV infection, which principally manifests as severe abdominal pain, with potential stomach, intestine and spleen involvement. Furthermore, abdominal pain may appear several days before skin rashes, and such infections may be misdiagnosed for other acute abdomen, lupus mesenteric vasculitis or thromboembolic diseases. Thus, prompt and accurate diagnosis and the early initiation of antiviral therapy are particularly important for avoiding severe life-threatening complications.