Gastro-intestinal Involvement of Primary Varicella Zoster Virus Infection in a Renal Transplant Recipient

Biopsy proven gastro-intestinal involvement of Varicella Zoster Virus (VZV) infection is rare and has not previously been reported in renal transplant recipients. This case report concerns a 65 year old, VZV seronegative, renal transplant recipient who presented with a non-vesicular rash and abdominal pain. Endoscopy revealed gastro-duodenal ulceration and in gastric biopsies VZV-DNA was detected by polymerase chain reaction assay. We conclude that abdominal pain in the absence of vesicular skin lesions may be the presenting symptom of visceral VZV infection, a potentially life threatening disease. To diminish the risk of VZV infection, patients on the waiting list for transplantation who are VZV seronegative or have non-protective VZV-IgG antibody titers, it is advised to vaccinate for VZV prior to transplantation.