Acute Pancreatitis: Presenting Manifestation of Varicella Infection

A 29-year-old man presented with symptoms suggestive of acute pancreatitis of 3 day's duration. No definite aetiology was identifiable at admission. The patient had been receiving corticosteroids for the preceding 1 month, after the evacuation of a traumatic subdural haematoma. During the hospital stay, he developed a macular skin rash, which evolved over a period of 48 hours to a papulovesicular rash typical of varicella infection. Liver function tests were suggestive of anicteric hepatitis. Acyclovir therapy was instituted. However, the patient succumbed to an episode ventricular arrhythmia of sudden onset, possibly due to varicella myocarditis. A high index of suspicion for varicella infection in immunocompromised patients presenting with acute pancreatitis is necessary for early diagnosis. The rash may at times be atypical and may rarely appear after the onset of pancreatitis. Whenever any rash develops in the setting of pancreatitis of unknown aetiology, rapid diagnostic tests should be undertaken to establish the diagnosis and start appropriate therapy.