PW Ko, CW Leung, NK Leung

We report an unusual case of varicella-zoster hepatitis which resulted in fatal massive hepatic necrosis in a 13 year old Chinese girl. Severe abdominal pain had been a prominent symptom since day two of the disease. Past medical history and clinical examination did not suggest any immunodeficiency. The clinical course rapidly progressed to disseminated intravascular coagulation and death. Autopsy revealed diffuse haemorrhagic necrosis of liver and evidence of varicella in lung and kidneys. Death from fulminant hepatic necrosis secondary to varicella infection is a rare occurrence and in the past it has been seen only in immunocompromised patients such as transplant recipients, persons receiving corticosteroids, and patients with human immunodeficiency virus infection. Severe abdominal pain was described in case reports from this kind of patients. We believe that the occurrence of such pain should make one on alert of more sinister disease going on if the origin of the pain cannot be delineated. To our knowledge, this is the first report of a fatal case of varicella hepatitis in a previously healthy, immunocompetent, paediatric patients.