D0556 - A Peculiar Case of Fatal Concomitant Acute Pancreatitis and Fulminant Hepatitis Due to Disseminated Varicella Zoster Infection

Dariush Shahsavari, MD¹, Praneeth Kudaravalli, MD², Kwabena O. Adu-Gyamfi, MBChB¹, John Erikson L. Yap, MD³, Viveksandeep Chandrasekar, MBBS³, Zain A. Sobani, MD^4
1Medical College of Georgia - Augusta University, Augusta, GA; ²Augusta University Medical Center, Augusta, GA; ³Augusta University Medical College of Georiga, Augusta, GA; ⁴Augusta University/Medical College of Georgia, Augusta, GA

Introduction: Disseminated Varicella Zoster virus (DVZV) can be associated with elevated liver enzymes. DVZV-associated acute pancreatitis is rarely reported. Fulminant hepatitis due to DVZV is even less frequently reported and is usually deadly. We present a case of concomitant acute pancreatitis and fulminant liver failure due to DVZV in an HIV/AIDS patient.

Case Description/Methods: A 44-year-old Caucasian male with a history of asthma and traumatic splenectomy was admitted for persistent epigastric pain radiating to the back and vesicular skin rash. No history of smoking, alcohol abuse, and illicit drug use. His current medications are his asthma inhalers and fluconazole treatment for fungal infection which was started 5 days prior. His vitals were within normal limits except for tachycardia of 105 beats/min. His symptoms worsened and he started having non-bloody vomiting and oral intolerance. His vesicular rash progressed and now involved the left ear, entire abdomen, back, and extremities including palms with no pain or itching. His labs were significant for elevated lipase 273 U/L, AST 281 U/L, ALT 228 U/L, Alkaline phosphatase 216 U/L, Total bilirubin 1.2 mg/dL, with negative viral hepatitis panel, HSV, and syphilis serology. Acute and chronic liver disease work-up were all negative. HIV was reactive (CD4 count of 14). Abdominal CT showed severe edematous pancreatitis. Ultrasound and MRI did not reveal any obstructions or ductal dilatation. Patient was treated with IV fluids and symptom control for acute pancreatitis. His symptoms continued to worsen, and his mental status deteriorated. The rash became more diffuse spreading to the entire body. Skin shave biopsy showed VZV as well as positive VZV serology. Patient was started on IV acyclovir and was planned for a liver biopsy as AST and ALT above 1000 U/L with a total bilirubin of 11.9 mg/dL. Patient ultimately suffered a cardiac arrest and died a week after admission.

Discussion: DVZV infection has been reported mainly in solid organ transplants and hematologic malignancies receiving chemotherapy. Our patient had a history of splenectomy and previously undiagnosed HIV/AIDS not on treatment. There have been a few DVZV-associated acute pancreatitis cases reported, and fulminant hepatitis is even less frequent and has been often deadly. In conclusion, concomitant pancreatitis and fulminant hepatitis can occur in DVZV infections and need to be considered in the differential diagnosis especially in patients presenting with vesicular skin lesions.


Disclosures:


Dariush Shahsavari, MD¹, Praneeth Kudaravalli, MD², Kwabena O. Adu-Gyamfi, MBChB¹, John Erikson L. Yap, MD³, Viveksandeep Chandrasekar, MBBS³, Zain A. Sobani, MD⁴. D0556 - A Peculiar Case of Fatal Concomitant Acute Pancreatitis and Fulminant Hepatitis Due to Disseminated Varicella Zoster Infection, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.