{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:06:39Z","timestamp":1791313599195,"version":"4.3.1"},"reference-count":180,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T00:00:00Z","timestamp":1755561600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Visceral disseminated varicella-zoster virus infection (VD-VZV) involves the hematogenous spread of VZV from the skin to the internal organs. Though rare, it is potentially life-threatening, predominantly affecting immunocompromised individuals. Diagnosis is often delayed due to nonspecific symptoms mimicking other viral illnesses. While the vesicular rash is a hallmark sign, it is absent in approximately 5% of cases. Visceral involvement may precede cutaneous lesions, complicate early recognition, and increase the risk of severe complications. This scoping review screened 594 articles of which 153 met the inclusion criteria, yielding 156 individual cases. Patients were predominantly male (53.8%), with a mean age of 42.3 years. The overall mortality rate was 25.0%. Multiple organs were involved in 46.1% of cases. The most frequently affected were the lungs (56%), liver (44%), heart (16%), kidneys (11%), pancreas (11%), stomach (10%), and esophagus (6%). Antivirals were administered in 89.1% of cases, while corticosteroids were used in 22.4%, with no significant impact on outcomes. Early diagnosis, achieved in 65.4% of patients, was significantly associated with survival (p = 0.043). Mortality was significantly associated with underlying comorbidities (p = 0.004), especially autoimmune diseases requiring immunosuppression (p = 0.048). Septic shock or multi-organ dysfunction (MODS), hepatitis, acute kidney injury, and acute liver failure were linked to higher mortality in univariate analysis. Multivariate analysis identified comorbidities (p &lt; 0.001), septic shock\/MODS (p = 0.008), and acute liver failure (p = 0.039) as independent predictors of mortality. Patients with septic shock\/MODS had over twice the risk of death (OR = 2.24; p = 0.008). This review underscores the diagnostic challenges and high mortality of VD-VZV. Early recognition and timely administration of antiviral treatment appear critical for survival. Greater clinical awareness and further research are needed to guide management.<\/jats:p>","DOI":"10.3390\/v17081135","type":"journal-article","created":{"date-parts":[[2025,8,19]],"date-time":"2025-08-19T10:59:01Z","timestamp":1755601141000},"page":"1135","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Disseminated Varicella-Zoster Virus Infection with Internal Organ Involvement: A Scoping Review of 156 Cases"],"prefix":"10.3390","volume":"17","author":[{"given":"Aleksandar","family":"Timotijevic","sequence":"first","affiliation":[{"name":"Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA"},{"name":"Internal Medicine Residency Program, Franciscan Health Olympia Fields Hospital, Olympia Fields, IL 60461, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8240-1937","authenticated-orcid":false,"given":"Pratyusha","family":"Kodela","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vladislav","family":"Glu\u0161ac","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Belgrade, 11000 Belgrade, Serbia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-9563-830X","authenticated-orcid":false,"given":"Sara","family":"Bokonjic","sequence":"additional","affiliation":[{"name":"Institute of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital, Heinrich Heine University, 40225 Dusseldorf, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3794-2539","authenticated-orcid":false,"given":"Bojan","family":"Joksimovic","sequence":"additional","affiliation":[{"name":"Department of Pathological Physiology, Faculty of Medicine, University of East Sarajevo, 73300 Foca, Bosnia and Herzegovina"},{"name":"Department of Pediatrics, ASA Hospital, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Vera Gomez","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA"},{"name":"Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Ladin","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA"},{"name":"Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5312-8812","authenticated-orcid":false,"given":"Igor","family":"Dumic","sequence":"additional","affiliation":[{"name":"Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, USA"},{"name":"Mayo Clinic College of Medicine and Science, Rochester, MN 55905, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/82_2010_10","article-title":"The varicella-zoster virus genome","volume":"342","author":"Cohen","year":"2010","journal-title":"Varicella-Zoster Virus"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S68","DOI":"10.1093\/infdis\/jiy403","article-title":"Immunobiology of Varicella-Zoster Virus Infection","volume":"218","author":"Laing","year":"2018","journal-title":"J. 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