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Fulminant varicella hepatitis: a rare but lethal cause of abdominal pain
  1. Christopher Fang,
  2. Junice Wong and
  3. Wei Wen Ang
  1. Department of General Surgery, Tan Tock Seng Hospital, National Healthcare Group, Singapore
  1. Correspondence to Dr Christopher Fang; Christopher.fang{at}


An 81-year-old woman with no history of immunocompromise presented with 2 days of upper abdominal pain associated with nausea. On arrival, her physical examination was unremarkable apart from mild epigastric and right hypochondriac tenderness, and laboratory investigations were unremarkable apart from mild thrombocytopenia and transaminitis. A CT scan performed on the day of admission revealed a tiny 0.3 cm stone in the common bile duct, with no upstream dilatation. On day 2 of admission, she developed a vesicular rash and with acutely worsening transaminitis. She deteriorated rapidly and demised from complications of acute liver failure within the next 24 hours. The diagnosis of varicella was confirmed with antibody testing. Fulminant varicella hepatitis is an extremely rare and lethal condition with only a handful of reported cases in the current literature. We aim to share our clinical experience and summarise the salient points from existing case reports.

  • liver disease
  • general surgery

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  • Contributors First author CF was involved in the data collection and preparation of the manuscript. Second and third authors JW and WWA are senior authors whose advice, expertise and guidance were invaluable in the preparation and final editing of this manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.