{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:03:26Z","timestamp":1790759006237,"version":"4.1.0"},"reference-count":10,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"vor","delay-in-days":272,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Critical Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Visceral disseminated varicella\u2010zoster virus (VD\u2010VZV) infection is an uncommon but potentially life\u2010threatening manifestation of varicella infection that primarily affects immunocompromised patients. When hematogenous dissemination occurs, the risk of significant organ dysfunction and death increases considerably. The disease develops through systemic viral spread to visceral organs, resulting in widespread multisystem involvement. Patients with Evans syndrome may be at increased risk because of underlying immune dysregulation and the frequent need for immunosuppressive treatment. We report the case of a 5\u2010year\u2010old unvaccinated child with Evans syndrome who developed severe multiorgan failure secondary to VD\u2010VZV infection. The patient\u2032s condition was refractory to medical management but was successfully supported with venoarterial extracorporeal membrane oxygenation (VA\u2010ECMO), without bleeding complications despite profound thrombocytopenia. A modified anticoagulation strategy and aggressive platelet support were used. The patient was successfully decannulated after 8 days of ECMO without major hemorrhagic complications and subsequently recovered renal and hepatic function. This case highlights the fulminant nature of VD\u2010VZV infection in an unvaccinated patient with Evans syndrome. It demonstrates that survival is possible with timely initiation of antiviral therapy and extracorporeal support.<\/jats:p>","DOI":"10.1155\/crcc\/2103304","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:28:01Z","timestamp":1790756881000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Disseminated Varicella Zoster and Multiorgan Failure Requiring ECMO Support in a Patient With Evans Syndrome"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7992-8212","authenticated-orcid":false,"given":"Rachel E.","family":"Gahagen","sequence":"first","affiliation":[{"name":"Division of Pediatric Critical Care Department of Pediatrics Northwestern University Feinberg School of Medicine  Chicago Illinois USA  northwestern.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9416-7113","authenticated-orcid":false,"given":"Riad","family":"Lutfi","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Department of Pediatrics Indiana University School of Medicine  Indianapolis Indiana USA  iusb.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6016-2325","authenticated-orcid":false,"given":"Mara E.","family":"Nitu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Department of Pediatrics Indiana University School of Medicine  Indianapolis Indiana USA  iusb.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jatinder K.","family":"Dhami","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Department of Pediatrics Methodist Children\u2032s Hospital  San Antonio Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John C.","family":"Christenson","sequence":"additional","affiliation":[{"name":"Ryan White Center for Pediatric Infectious Diseases and Global Health Department of Pediatrics Indiana University School of Medicine  Indianapolis Indiana USA  iusb.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8198-5099","authenticated-orcid":false,"given":"Daniel T.","family":"Cater","sequence":"additional","affiliation":[{"name":"Division of Pediatric Critical Care Department of Pediatrics Indiana University School of Medicine  Indianapolis Indiana USA  iusb.edu"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"e_1_2_8_1_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198312083092306"},{"key":"e_1_2_8_2_2","doi-asserted-by":"publisher","DOI":"10.1542\/peds.68.5.735"},{"key":"e_1_2_8_3_2","doi-asserted-by":"publisher","DOI":"10.3390\/v17081135"},{"key":"e_1_2_8_4_2","first-page":"378","article-title":"Extracorporeal Membrane Oxygenation for Chickenpox Pneumonia: A Single Institution\u2032s Experience","volume":"49","author":"White R. 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