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Case report
peer-reviewed

A Unique Case of Acute Cerebral Venous Sinus Thrombosis Secondary to Primary Varicella Zoster Virus Infection



Abstract

Primary varicella zoster virus (VZV) infection, predominantly in the pediatric population, presents with pyrexia and a classic pruritic vesicular rash. In adults, although less common, it is more severe and linked to more complications. Neurological complications, which account for less than 1% of all VZV complications, include meningitis, encephalitis, arterial vasculopathy, and venous thrombosis. We present a case of a 39-year-old male who developed extensive cerebral venous sinus thrombosis following primary VZV infection. Venous thrombosis in VZV has been suggested to be caused by autoantibodies against protein S, pre-existing hypercoagulability, or endothelial damage. The patient was acutely managed using intravenous acyclovir and heparin. Long-term anticoagulation therapy with warfarin was continued after discharge. We concluded that clinicians should be aware of the rare complications of this common pathology so that a timely diagnosis can be made, followed by prompt management. Further studies need to be done to better understand acute cerebral venous sinus thrombosis secondary to VZV.



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Case report
peer-reviewed

A Unique Case of Acute Cerebral Venous Sinus Thrombosis Secondary to Primary Varicella Zoster Virus Infection


Author Information

Syed F. Imam

Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan

Omair ul haq Lodhi

Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan

Zainab Fatima Corresponding Author

Medicine, Shifa International Hospital, Islamabad, Pakistan

Saneeya Nasim

Department of Neurology, Shifa International Hospital, Islamabad, Pakistan

Waseem T. Malik

Department of Neurology, Shifa International Hospital, Islamabad, Pakistan

Muhammad Sabih Saleem

Medicine, Shifa International Hospital, Islamabad, Pakistan


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Case report
peer-reviewed

A Unique Case of Acute Cerebral Venous Sinus Thrombosis Secondary to Primary Varicella Zoster Virus Infection


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Case report
peer-reviewed

A Unique Case of Acute Cerebral Venous Sinus Thrombosis Secondary to Primary Varicella Zoster Virus Infection

Syed F. Imam">Syed F. Imam, Omair ul haq Lodhi">Omair ul haq Lodhi, Zainab Fatima">Zainab Fatima , Saneeya Nasim">Saneeya Nasim, Waseem T. Malik">Waseem T. Malik, Muhammad Sabih Saleem">Muhammad Sabih Saleem

  • Author Information
    Syed F. Imam

    Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan

    Omair ul haq Lodhi

    Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan

    Zainab Fatima Corresponding Author

    Medicine, Shifa International Hospital, Islamabad, Pakistan

    Saneeya Nasim

    Department of Neurology, Shifa International Hospital, Islamabad, Pakistan

    Waseem T. Malik

    Department of Neurology, Shifa International Hospital, Islamabad, Pakistan

    Muhammad Sabih Saleem

    Medicine, Shifa International Hospital, Islamabad, Pakistan


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: September 16, 2017

    DOI

    10.7759/cureus.1693

    Cite this article as:

    Imam S F, Lodhi O, Fatima Z, et al. (September 16, 2017) A Unique Case of Acute Cerebral Venous Sinus Thrombosis Secondary to Primary Varicella Zoster Virus Infection. Cureus 9(9): e1693. doi:10.7759/cureus.1693

    Publication history

    Received by Cureus: August 07, 2017
    Peer review began: September 07, 2017
    Peer review concluded: September 11, 2017
    Published: September 16, 2017

    Copyright

    © Copyright 2017
    Imam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Primary varicella zoster virus (VZV) infection, predominantly in the pediatric population, presents with pyrexia and a classic pruritic vesicular rash. In adults, although less common, it is more severe and linked to more complications. Neurological complications, which account for less than 1% of all VZV complications, include meningitis, encephalitis, arterial vasculopathy, and venous thrombosis. We present a case of a 39-year-old male who developed extensive cerebral venous sinus thrombosis following primary VZV infection. Venous thrombosis in VZV has been suggested to be caused by autoantibodies against protein S, pre-existing hypercoagulability, or endothelial damage. The patient was acutely managed using intravenous acyclovir and heparin. Long-term anticoagulation therapy with warfarin was continued after discharge. We concluded that clinicians should be aware of the rare complications of this common pathology so that a timely diagnosis can be made, followed by prompt management. Further studies need to be done to better understand acute cerebral venous sinus thrombosis secondary to VZV.



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Syed F. Imam, M.D.

Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan

Omair ul haq Lodhi, M.D.

Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan

Zainab Fatima, M.D.

Medicine, Shifa International Hospital, Islamabad, Pakistan

For correspondence:
zainab_fatima101@hotmail.com

Saneeya Nasim, Resident Physician

Department of Neurology, Shifa International Hospital, Islamabad, Pakistan

Waseem T. Malik

Department of Neurology, Shifa International Hospital, Islamabad, Pakistan

Muhammad Sabih Saleem, M.D.

Medicine, Shifa International Hospital, Islamabad, Pakistan

Syed F. Imam, M.D.

Department of Internal Medicine, Shifa International Hospital, Islamabad, Pakistan

Omair ul haq Lodhi, M.D.

Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan

Zainab Fatima, M.D.

Medicine, Shifa International Hospital, Islamabad, Pakistan

For correspondence:
zainab_fatima101@hotmail.com

Saneeya Nasim, Resident Physician

Department of Neurology, Shifa International Hospital, Islamabad, Pakistan

Waseem T. Malik

Department of Neurology, Shifa International Hospital, Islamabad, Pakistan

Muhammad Sabih Saleem, M.D.

Medicine, Shifa International Hospital, Islamabad, Pakistan