{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T22:23:17Z","timestamp":1793312597030,"version":"4.5.0"},"reference-count":21,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,8,22]]},"published-print":{"date-parts":[[2021,9]]},"abstract":"<jats:p>An 81-year-old woman with no history of immunocompromise presented with 2 days of upper abdominal pain associated with nausea. On arrival, her physical examination was unremarkable apart from mild epigastric and right hypochondriac tenderness, and laboratory investigations were unremarkable apart from mild thrombocytopenia and transaminitis. A CT scan performed on the day of admission revealed a tiny 0.3 cm stone in the common bile duct, with no upstream dilatation. On day 2 of admission, she developed a vesicular rash and with acutely worsening transaminitis. She deteriorated rapidly and demised from complications of acute liver failure within the next 24 hours. The diagnosis of varicella was confirmed with antibody testing. Fulminant varicella hepatitis is an extremely rare and lethal condition with only a handful of reported cases in the current literature. We aim to share our clinical experience and summarise the salient points from existing case reports.<\/jats:p>","DOI":"10.1136\/bcr-2021-244081","type":"journal-article","created":{"date-parts":[[2021,9,3]],"date-time":"2021-09-03T12:12:26Z","timestamp":1630671146000},"page":"e244081","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Fulminant varicella hepatitis: a rare but lethal cause of abdominal pain"],"prefix":"10.1136","volume":"14","author":[{"given":"Christopher","family":"Fang","sequence":"first","affiliation":[{"name":"Department of General Surgery, Tan Tock Seng Hospital, National Healthcare Group, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junice","family":"Wong","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Tan Tock Seng Hospital, National Healthcare Group, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei Wen","family":"Ang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Tan Tock Seng Hospital, National Healthcare Group, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,9,3]]},"reference":[{"key":"2025082709094321000_14.9.e244081.1","doi-asserted-by":"crossref","DOI":"10.1186\/s12879-019-4193-y","article-title":"Successful management of visceral disseminated varicella zoster virus infection during treatment of membranous nephropathy: a case report","volume":"19","author":"Furuto","year":"2019","journal-title":"BMC Infect Dis"},{"key":"2025082709094321000_14.9.e244081.2","doi-asserted-by":"publisher","DOI":"10.1080\/00365540600561785"},{"key":"2025082709094321000_14.9.e244081.3","doi-asserted-by":"crossref","first-page":"1215","DOI":"10.1016\/j.healun.2009.06.017","article-title":"Fulminant hepatic failure due to varicella zoster in a heart transplant patient: successful liver transplant","volume":"28","author":"Alvite-Canosa","year":"2009","journal-title":"J Heart Lung Transplant"},{"key":"2025082709094321000_14.9.e244081.4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1055\/s-2007-963376","article-title":"Postoperative fulminant varicella zoster virus hepatitis with fatal outcome: a case report","volume":"46","author":"Drebber","year":"2008","journal-title":"Z Gastroenterol"},{"key":"2025082709094321000_14.9.e244081.5","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.2169\/internalmedicine.52.0118","article-title":"Varicella-Zoster virus-associated fulminant hepatitis following allogeneic hematopoietic stem cell transplantation for multiple myeloma","volume":"52","author":"Saitoh","year":"2013","journal-title":"Intern Med"},{"key":"2025082709094321000_14.9.e244081.6","doi-asserted-by":"crossref","first-page":"1184","DOI":"10.1016\/j.transproceed.2011.01.142","article-title":"Fulminant multiorgan failure due to varicella zoster virus and HHV6 in an immunocompetent adult patient, and anhepatia","volume":"43","author":"Maggi","year":"2011","journal-title":"Transplant Proc"},{"key":"2025082709094321000_14.9.e244081.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2006.06.004"},{"key":"2025082709094321000_14.9.e244081.8","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jcv.2010.09.014","article-title":"Fulminant hepatitis and death associated with disseminated varicella in an immunocompromised adult from the Czech Republic caused by a wild-type clade 4 varicella-zoster virus strain","volume":"50","author":"Plisek","year":"2011","journal-title":"J Clin Virol"},{"key":"2025082709094321000_14.9.e244081.9","first-page":"423","article-title":"Fatal massive hepatic necrosis from varicella-zoster hepatitis","volume":"74","author":"Ross","year":"1980","journal-title":"Am J Gastroenterol"},{"key":"2025082709094321000_14.9.e244081.10","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2018\/1269340","article-title":"Acute liver failure due to disseminated varicella zoster infection","volume":"2018","author":"Brewer","year":"2018","journal-title":"Case Reports Hepatol"},{"key":"2025082709094321000_14.9.e244081.11","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1016\/j.amsu.2019.10.034","article-title":"Rare presentation of primary varicella zoster as fatal fulminant hepatitis in adult on low-dose,short-term steroid: Case report","volume":"48","author":"Toffaha","year":"2019","journal-title":"Ann Med Surg"},{"key":"2025082709094321000_14.9.e244081.12","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1007\/s10620-006-8037-4","article-title":"Fatal varicella-zoster hepatitis presenting with severe abdominal pain: a case report and review of the literature","volume":"51","author":"Pishvaian","year":"2006","journal-title":"Dig Dis Sci"},{"key":"2025082709094321000_14.9.e244081.13","first-page":"376","article-title":"Acyclovir therapy of severe chickenpox in an adult renal transplant patient","volume":"2","author":"Morales","year":"1987","journal-title":"Nephrol Dial Transplant"},{"key":"2025082709094321000_14.9.e244081.14","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(90)90133-X"},{"key":"2025082709094321000_14.9.e244081.15","doi-asserted-by":"publisher","DOI":"10.1016\/0163-4453(92)93681-F"},{"key":"2025082709094321000_14.9.e244081.16","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1994.00420180111013"},{"key":"2025082709094321000_14.9.e244081.17","doi-asserted-by":"crossref","first-page":"310","DOI":"10.3947\/ic.2019.51.3.310","article-title":"Successful treatment of fulminant hepatitis due to varicella zoster virus using immunoglobulin in a kidney transplant patient","volume":"51","author":"Hsing","year":"2019","journal-title":"Infect Chemother"},{"key":"2025082709094321000_14.9.e244081.18","doi-asserted-by":"publisher","DOI":"10.1086\/514613"},{"key":"2025082709094321000_14.9.e244081.19","doi-asserted-by":"publisher","DOI":"10.1086\/517211"},{"key":"2025082709094321000_14.9.e244081.20","unstructured":"Varicella . Vaccine preventable diseases surveillance Standards, World Health Organization, 2018. Available: https:\/\/www.who.int\/publications\/m\/item\/vaccine-preventable-diseases-surveillance-standards-varicella"},{"key":"2025082709094321000_14.9.e244081.21","unstructured":"Centers for Disease Control . Manual for the surveillance of vaccine-preventable diseases, chapter 17, 2018. Available: https:\/\/www.cdc.gov\/vaccines\/pubs\/surv-manual\/chpt17-varicella.html"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-244081","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T16:09:50Z","timestamp":1756310990000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-244081"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9]]},"references-count":21,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2021,9,3]]},"published-print":{"date-parts":[[2021,9]]}},"alternative-id":["10.1136\/bcr-2021-244081"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-244081","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9]]}}}