Skip to main content
SpringerLink
Log in

Disseminated intravascular coagulation (DIC) and rhabdomyolysis in fulminant varicella infection— Case report and review of the literature

  • Case Report
  • Published:
Infection Aims and scope Submit manuscript

Summary

Primary infection with varicella-zoster virus usually is a mild, self-limiting childhood illness. However, certain rare but potentially life-threatening complications can be associated with the disease. Adults and immunosuppressed patients are at increased risk for these events. We report a case of a patient on chronic immunosuppressants with fulminant varicella infection complicated by rhabdomyolysis and disseminated intravascular coagulation. Mechanisms of muscle damage in viral diseases might be direct invasion of skeletal muscle and/or induction of harmful cytokines. Aggressive fluid therapy, alkalinization of urine and supportive measures correcting electrolyte imbalances, hypothermia and hypoxemia should result, in preservation or complete restoration of renal function. Disseminated intravascular coagulation occurs in conjunction with various diseases and may range from mild laboratory abnormalities to fulminant lethal thrombosis and bleeding. Apart from elimination of the causative process therapeutic strategies are still highly disputed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Centers of Disease Control: Variacella-related dealths among adults— United States, 1997. MMWR 46 (1997) 409–412.

    Google Scholar 

  2. Bachli, E., Kagi, M. K., Krause, M.: Viszerale und neurologische Komplikationen bei Varizellen-Infektionen des Erwachsenen. Schweiz. Med. Wochenschr. 126 (1996) 440–446.

    PubMed  CAS  Google Scholar 

  3. Gogos, C. A., Bassaris, H. P., Vagenakis, A. G.: Varicella pneumonia in adults. A review of pulmonary manifestations, risk factors and treatment. Respiration 59 (1992) 339–343.

    PubMed  CAS  Google Scholar 

  4. Feldman, S., Lott, L.: Varicella in children with cancer: impact of antiviral therapy and prophylaxis. Pediatrics 80 (1987) 465–472.

    PubMed  CAS  Google Scholar 

  5. Rowland, P., Wald, E. R., Mirro, J. R., Jr.,Yunis, E., Albo, V. C., Wollman, M. R., Blatt, J.: Progressive varicella presenting with pain and minimal skin involvement in children with acute lymphoblastic leukemia. J. Clin. Oncol. 13 (1996) 1697–1703.

    Google Scholar 

  6. Lynfield, R., Herrin, J. T., Rubin, R. H.: Varicella in pediatric, renal transplantation patients. Pediatrics 90 (1992) 216–220.

    PubMed  CAS  Google Scholar 

  7. Rogers, S. Y., Irving, W., Harris, A., Russell, N. H.: Visceral varicella zoster infection after bone marrow transplantation without skin involvement and the use of PCR for diagnosis. Bone Marrow Transplant. 15 (1995) 805–807.

    PubMed  CAS  Google Scholar 

  8. Gershon, A., Brunell, P. A., Doyle, E. F.: Steroid therapy and varicella. J. Pediatr. (1973) 1032–1039.

  9. Starr, S. E.: Varicella in children receiving steroids for asthma: risks and management. Pediatr. Infect. Dis. 11 (1992) 419–420.

    Article  CAS  Google Scholar 

  10. Haller, R. G., Knochel, J. P.: Skeletal muscle disease in alcoholism. Med. Clin. North Am. 68 (1984) 91–103.

    PubMed  CAS  Google Scholar 

  11. Curry S. C., Chang, D., Connor, D. F.: Drug- and toxin-induced rhabdomyolysis. Ann. Emerg. Med. 18 (1989) 1068–1083.

    Article  PubMed  CAS  Google Scholar 

  12. Rowland, L. P., Penn, A. S.: Myoglobinuria. Med. Clin. North Am. 56 (1972) 1233–1256.

    PubMed  CAS  Google Scholar 

  13. Sinert, R., Kohl, L., Rainone, T.: Exercise-induced rhabdomyolysis. Ann. Emerg Med. 23 (1994) 1301–1306.

    Article  PubMed  CAS  Google Scholar 

  14. Grossman, R. A., Hamilton, R. W., Morse, B. M., Penn, A. S., Goldberg, M.: Nontraumatic rhabdomyolysis and acute renal failure. N. Engl. J. Med. 291 (1974) 807–811.

    PubMed  CAS  Google Scholar 

  15. Brivet, F., Pham Van, T., Petitpretz, P., Delfraissy, J. F.: Rhabdomyolysis, acute renal failure and Legionnaire’s disease. Chest 86 (1984) 943–944.

    PubMed  CAS  Google Scholar 

  16. Asao, K., Utsunomiya, Y., Hirano, K.: Rhabdomyolysis associated with bacteremia due toStreptococcus viridams. Intern. Med. 34 (1995) 785–789.

    Article  PubMed  CAS  Google Scholar 

  17. Falasca, G. F., Reginato, A. J.: The spectrum of myositis and rhabdomyolysis associated with bacterial infection. J. Rheumatol. 21 (1994) 1932–1937.

    PubMed  CAS  Google Scholar 

  18. Knochel, J. P.: Mechanisms of rhabdomyolysis. Curr. Opin. Rheumatol. 5 (1992) 725–731.

    Article  Google Scholar 

  19. Leebeek, F. W., Baggen, M. G., Mulder, L. J., Dingemans-Dumas, A. M.: Rhabdomyolysis associated with influenza A virus infection. Neth. J. Med. 46 (1995) 189–192.

    Article  PubMed  CAS  Google Scholar 

  20. Paletta, C. E., Lynch, R., Knutsen, A. P.: Rhabdomyolysis and lower extremity compartment syndrome due to influenza B virus. Ann. Plast. Surg. 30 (1993) 272–273.

    Article  PubMed  CAS  Google Scholar 

  21. Singh, U., Scheld, W. M.: Infectious etiologies of rhabdomyolysis: three case reports and review. Clin. Infect. Dis. 22 (1996) 642–649.

    PubMed  CAS  Google Scholar 

  22. Osamah, H., Finkelstein, R., Brook, J. G.: Rhabdomyolysis complicating acute Epstein-Barr virus infection. Infection 23 (1995) 119–120.

    Article  PubMed  CAS  Google Scholar 

  23. Schhlesinger, M. J., Gandara, D., Bensch, K. G.: Myoglobinuria associated with herpes-group viral infection. Arch. Intern. Med., 138 (1978), 422–424.

    Article  Google Scholar 

  24. Gherardi, R., Chariot, P., Authier, F. J.: Muscular involvement in HIV infection. Rev. Neurol. Paris 151 (1995) 603–607.

    PubMed  CAS  Google Scholar 

  25. Roberts, D. E.: Varicella zoster infection, massive rhabdomyolysis, myoglobinuria, and renal failure. J. Am. Board Fam. Pract 8 (1995) 52–54.

    PubMed  CAS  Google Scholar 

  26. Pratt, R. D., Bradley, J. S., Loubert, C.: Rhabdomyolysis associated with acute varicella infection. Clin. Infect. Dis. 20 (1995) 450–453.

    PubMed  CAS  Google Scholar 

  27. Will, M. J., Hecker, R. B., Wathen, P. I.: Primary varicella-zoster-induced rhabdomyolysis. South. Med. J. 89 (1996) 915–920.

    PubMed  CAS  Google Scholar 

  28. Brick, R. L.: Disseminated intravascular coagulation. Hematol. Oncol. Clin. North Am. 6 (1992) 259–264.

    Google Scholar 

  29. Steiner, P. E., Lushbough, C. C.: Maternal pulmonary embolism by amniotic fluid as a cause of shock and unexplained deaths in obstetrics. JAMA 117 (1941) 1245–1247.

    Google Scholar 

  30. Roberts, J. M., May, W. J.: Consumption coagulopathy in severe preeclampsia. Obstet. Gynecol. 48 (1976) 163–167.

    PubMed  CAS  Google Scholar 

  31. Levi, M., ten Cate, H., van der Poll, T., van Deventer, S. J. H.: Pathogenesis of disseminated intravascular coagulation in sepsis. JAMA 270 (1993) 975–979.

    Article  PubMed  CAS  Google Scholar 

  32. Abildgaard, C. F., Corrigan, J. J., Seeler, R. A., Simone, J. V., Schulman, I.: Meningiococcemia associated with intravascular coagulation. Pediatrics 40 (1967) 78–81.

    PubMed  CAS  Google Scholar 

  33. Cronberg, S., Skansberg, P., Nivenios-Larsson, K.: Disseminated intravascular coagulation in septicemia caused by beta-hemolytic streptococci. Thromb Res. 3 (1973) 405–409.

    Article  Google Scholar 

  34. Feusner, J. H., Slichter, S. J., Harker, L. A.: Mechanisms of thrombocytopenia in varicella. Am. J. Hematol. 7 (1979) 255–262.

    Article  PubMed  CAS  Google Scholar 

  35. Preblud, S. R.: Varicella: complications and costs. Pediatrics 78 (1986) 728–735.

    PubMed  CAS  Google Scholar 

  36. Chen, P. Y., Chu, H. Y., Shian, W. J., Shu, S. G., Chi, C. S.: Varicella-zoster virus infection in children with malignancy. Chung Hua I Hsueh Tsa Chih Taipei 54 (1994) 417–423.

    PubMed  CAS  Google Scholar 

  37. Myers, A. R., Bloch, K. J., Coleman, R. W.: A comparative study of four methods for detecting fibrinogen degradation products in patients with various diseases. N. Engl. J. Med. 283 (1970) 663.

    PubMed  Google Scholar 

  38. Rylatt, D. B., Blake, A. S., Cottis, L. E., Massingham, D. A., Fletcher, W. A., Masci, P. P., Whitaker, A. N., Elms, M., Bunce, I., Weber, A. J., Wyatt, D., Bundesen, P. G.: An immunoassay for human D-dimer using monoclonal antibodies Thromb Res. 31 (1983) 767–770.

    Article  PubMed  CAS  Google Scholar 

  39. Stopfkuchen, H., Jüngst, B. K., Wilutzky, H.: Purpura fulminans nach Varizellen und polyvalenter Impfung. Klin. Pädiatr. 188 (1976) 190–193.

    PubMed  CAS  Google Scholar 

  40. Wright, J. F., Blanchette, S. V., Wang, H., Arya, N., Petric, M., Semple, J. W., Chia, W. K., Freedman, J.: Characterization of platelet-reactive antibodies in children with varicella-associated acute, immune thrombocytopenic purpura (ITP). Br. J. Haematol. 95 (1996) 145–152.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Innere Medizin I, Abt. für Infektionen und Chemotherapie, Allgemeines Krankenhaus Wien, Währinger Gürtel 18-20, A-1090, Wien, Austria

    Ursula Hollenstein, F. Thalhammer & H. Burgmann

Authors
  1. Ursula Hollenstein
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Thalhammer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. H. Burgmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hollenstein, U., Thalhammer, F. & Burgmann, H. Disseminated intravascular coagulation (DIC) and rhabdomyolysis in fulminant varicella infection— Case report and review of the literature. Infection 26, 306–308 (1998). https://doi.org/10.1007/BF02962254

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02962254

Keywords

Search

Navigation