{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:06:51Z","timestamp":1787162811202,"version":"build-2736575974"},"reference-count":27,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2012,11,1]]},"abstract":"<jats:p>We report on an 18-year-old man with common variable immunodeficiency presenting with abdominal pain and vomiting due to gastric ulcers caused by reactivation of varicella-zoster virus (VZV). Endoscopy revealed multiple ulcers in the gastric antrum. Fever and rash developed the next day. Skin biopsy showed multinucleated cells with intranuclear inclusions highly suggestive of VZV infection, and high-dose intravenous acyclovir was started. VZV was detected on direct immunofluorescence from skin biopsy and polymerase chain reaction from endoscopic biopsy. His course was complicated by encephalopathy, pancreatitis, hepatitis, renal impairment, and hyponatremia. After 3 weeks of antiviral therapy, he gradually improved. Skin lesions cleared within a week. He remained well on follow-up 1 year later. Disseminated zoster presenting as gastric ulcers in the absence of the classic rash is unusual but has been reported in immunosuppressed patients with a history of bone marrow and stem cell transplant. We report this rare presentation in a patient with common variable immunodeficiency and highlight the importance of considering zoster as a cause for severe abdominal pain and of seeking endoscopic diagnosis to facilitate early therapy and reduced mortality risk.<\/jats:p>","DOI":"10.1542\/peds.2011-3491","type":"journal-article","created":{"date-parts":[[2012,10,8]],"date-time":"2012-10-08T21:01:54Z","timestamp":1349730114000},"page":"e1377-e1381","source":"Crossref","is-referenced-by-count":19,"title":["Gastric Ulcers Due to Varicella-Zoster Reactivation"],"prefix":"10.1542","volume":"130","author":[{"given":"Ki Lee","family":"Milligan","sequence":"first","affiliation":[{"name":"Department of Pediatrics,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ajay Kumar","family":"Jain","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"},{"name":"Divisions of Gastroenterology,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy S.","family":"Garrett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"},{"name":"Critical Care, and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan P.","family":"Knutsen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics,"},{"name":"Allergy & Immunology, Saint Louis University, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2012,11,1]]},"reference":[{"issue":"5","key":"2021120903554494800_B1","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1111\/j.1572-0241.1998.230_a.x","article-title":"Visceral varicella-zoster after bone marrow transplantation: report of a case series and review of the literature.","volume":"93","author":"David","year":"1998","journal-title":"Am J Gastroenterol"},{"issue":"3","key":"2021120903554494800_B2","first-page":"60","article-title":"Prevention of VZV infection in immunosuppressed patients using antiviral agents.","volume":"13","author":"Boeckh","year":"2006","journal-title":"Herpes"},{"key":"2021120903554494800_B3","first-page":"714","article-title":"Varicella-Zoster Infections","volume-title":"Red Book: 2009 Report of the Committee on Infectious Diseases","author":"American Academy of Pediatrics","year":"2009","edition":"28th ed."},{"issue":"1","key":"2021120903554494800_B4","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1159\/000092349","article-title":"Acute abdomen by varicella zoster virus induced gastritis after autologous peripheral blood stem cell transplantation in a patient with non-Hodgkin\u2019s lymphoma.","volume":"116","author":"Scholl","year":"2006","journal-title":"Acta Haematol"},{"issue":"5","key":"2021120903554494800_B5","first-page":"805","article-title":"Visceral varicella zoster infection after bone marrow transplantation without skin involvement and the use of PCR for diagnosis.","volume":"15","author":"Rogers","year":"1995","journal-title":"Bone Marrow Transplant"},{"issue":"4","key":"2021120903554494800_B6","doi-asserted-by":"crossref","first-page":"1424","DOI":"10.1182\/blood.V74.4.1424.1424","article-title":"Herpes zoster infection after autologous bone marrow transplantation.","volume":"74","author":"Schuchter","year":"1989","journal-title":"Blood"},{"issue":"12","key":"2021120903554494800_B7","doi-asserted-by":"crossref","first-page":"931","DOI":"10.1097\/MPH.0b013e31817e4b14","article-title":"Visceral varicella zoster virus (VZV) after allogeneic hematopoietic stem cell transplant (HSCT) in pediatric patients with chronic graft-versus-host disease (cGVHD).","volume":"30","author":"Peritz","year":"2008","journal-title":"J Pediatr Hematol Oncol"},{"issue":"3","key":"2021120903554494800_B8","doi-asserted-by":"crossref","first-page":"208","DOI":"10.1046\/j.1525-1470.1999.00055.x","article-title":"Primary disseminated varicella presenting as an acute abdomen.","volume":"16","author":"Kim","year":"1999","journal-title":"Pediatr Dermatol"},{"issue":"186","key":"2021120903554494800_B9","doi-asserted-by":"crossref","first-page":"S91","DOI":"10.1086\/342963","article-title":"Varicella-zoster virus: atypical presentations and unusual complications.","volume":"186","author":"Gnann","year":"2002","journal-title":"J Infect Dis"},{"issue":"11","key":"2021120903554494800_B10","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1136\/jcp.47.11.1054","article-title":"Varicella zoster gastritis in a bone marrow transplant recipient.","volume":"47","author":"McCluggage","year":"1994","journal-title":"J Clin Pathol"},{"issue":"5","key":"2021120903554494800_B11","doi-asserted-by":"crossref","first-page":"340","DOI":"10.1056\/NEJMcp013211","article-title":"Clinical practice. 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