The Association between Varicella and Acute Appendicitis: A Rare Case Report and Literature Review
Abstract
Varicella-zoster virus, the causative agent of chickenpox, is typically a self-limiting disease. However, in rare cases, it has been associated with atypical complications. Here, we report a unique case of acute appendicitis following varicella infection in an otherwise healthy individual. The possible mechanisms linking varicella to appendiceal inflammation remain unclear, but viral-induced immune dysregulation and secondary bacterial infection have been suggested. In our study, we aim to highlight this rare association, discuss potential pathophysiological mechanisms, and review the existing literature on similar cases.
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[2] Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, et al. Varicella zoster virus infection. Nat Rev Dis Primers. 2015 Jul 2;1:15016. https://doi.org/10.1038/nrdp.2015.16
[3] Wutzler P, Knuf M, Liese J. Varicella: efficacy of twodose vaccination in childhood. Dtsch Arztebl Int. 2008 Aug;105(33):567-72. https://doi.org/10.3238/arztebl.2008.0567
[4]Kliegman RM, Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, Graepel KW, Denison MR. Coronaviruses. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA. Elsevier. 2020:1742-5.
[5] Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007 Jul
25;298(4):438-51. https://doi.org/10.1001/jama.298.4.438
[6] Rentea RM, St Peter SD. Pediatric appendicitis. Surg Clin North Am. 2017;97(1):93-112. https://doi.org/10.1016/j.
suc.2016.08.009
[7] Dykes EH, Garland IW, Gray GR. Yersinia pseudotuberculosis with inflammation of the appendix: a case report. Scott Med J. 1987 Jun;32(3):82-3. https://doi.org/10.1177/003693308703200310
[8] Grynspan D, Rabah R. Adenoviral appendicitis presenting clinically as acute appendicitis. Pediatr Dev Pathol. 2008 MarApr;11(2):138-41. https://doi.org/10.2350/07-06-0299.1
[9] Wutzler P, Knuf M, Liese J. Varicella: efficacy of twodose vaccination in childhood. Dtsch Arztebl Int. 2008
Aug;105(33):567-72. https://doi.org/10.3238/arztebl.2008.0567
[10] de Costa A. The appendix-mucosal immunity and tolerance in the gut: consequences for the syndromes of appendicitis and its epidemiology. ANZ J Surg. 2022 Apr;92(4):653-60. https://doi.org/10.1111/ans.17522
[11] Soltani S, Kesheh MM, Siri G, Faramarzi S, Shahbahrami R, Didehdar M, et al. The role of viruses in human acute
appendicitis: a systematic literature review. Int J Colorectal Dis. 2023 Apr 18;38(1):102. https://doi.org/10.1007/s00384-023-04391-z
[12] Ziebold C, von Kries R, Lang R, Weigl J, Schmitt HJ. Severe complications of varicella in previously healthy children in Germany: a 1-year survey. Pediatrics. 2001 Nov;108(5):E79. https://doi.org/10.1542/peds.108.5.e79
[13] Alder AC, Fomby TB, Woodward WA, Haley RW, Sarosi G, Livingston EH. Association of viral infection and appendicitis. Arch Surg. 2010 Jan;145(1):63-71. https://doi.org/10.1001/archsurg.2009.250
[14] Pogorelić Z, Biocić M, Jurić I, Milunović KP, Mrklić I. Acute appendicitis as a complication of varicella. Acta
Medica (Hradec Kralove). 2012;55(3):150-2. https://doi.org/10.14712/18059694.2015.55
[15] Smedegaard LM, Christiansen CB, Melchior LC, Poulsen A. Appendicitis Caused by Primary Varicella Zoster Virus
Infection in a Child with DiGeorge Syndrome. Case Rep Pediatr. 2017;2017:6708046. https://doi.org/10.1155/2017/6708046
[16] Kilic S, Atici A, Kilincer A, Ozciftci G. A rare presentation of varicella: acute appendicitis. HK J Paediatr (New Series).
2017;22(3):179-80.
[17] Moon HM, Park BS, Moon DJ. Diagnostic Value of C-reactive Protein in Complicated Appendicitis. J Korean Soc
Coloproctol. 2011 Jun;27(3):122-6. https://doi.org/10.3393/jksc.2011.27.3.122
[18] Fennell J, Territo HM, Telt N, Wrotniak BH, Kozielski R, Pape E et al. The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children. J Emerg Med. 2024 Apr;66(4):e508-e15. https://doi.org/10.1016/j.jemermed.2023.11.016
[19] Glass CC, Rangel SJ. Overview and diagnosis of acute appendicitis in children. Semin Pediatr Surg. 2016 Aug;25(4):198-203. https://doi.org/10.1053/j.sempedsurg.2016.05.001
[20] Jumah S, Wester T. Non-operative management of acute appendicitis in children. Pediatr Surg Int. 2022 Nov 28;39(1):11. https://doi.org/10.1007/s00383-022-05284-y
oxfordjournals.bmb.a072952
[2] Gershon AA, Breuer J, Cohen JI, Cohrs RJ, Gershon MD, Gilden D, et al. Varicella zoster virus infection. Nat Rev Dis Primers. 2015 Jul 2;1:15016. https://doi.org/10.1038/nrdp.2015.16
[3] Wutzler P, Knuf M, Liese J. Varicella: efficacy of twodose vaccination in childhood. Dtsch Arztebl Int. 2008 Aug;105(33):567-72. https://doi.org/10.3238/arztebl.2008.0567
[4]Kliegman RM, Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, Graepel KW, Denison MR. Coronaviruses. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA. Elsevier. 2020:1742-5.
[5] Bundy DG, Byerley JS, Liles EA, Perrin EM, Katznelson J, Rice HE. Does this child have appendicitis? JAMA. 2007 Jul
25;298(4):438-51. https://doi.org/10.1001/jama.298.4.438
[6] Rentea RM, St Peter SD. Pediatric appendicitis. Surg Clin North Am. 2017;97(1):93-112. https://doi.org/10.1016/j.
suc.2016.08.009
[7] Dykes EH, Garland IW, Gray GR. Yersinia pseudotuberculosis with inflammation of the appendix: a case report. Scott Med J. 1987 Jun;32(3):82-3. https://doi.org/10.1177/003693308703200310
[8] Grynspan D, Rabah R. Adenoviral appendicitis presenting clinically as acute appendicitis. Pediatr Dev Pathol. 2008 MarApr;11(2):138-41. https://doi.org/10.2350/07-06-0299.1
[9] Wutzler P, Knuf M, Liese J. Varicella: efficacy of twodose vaccination in childhood. Dtsch Arztebl Int. 2008
Aug;105(33):567-72. https://doi.org/10.3238/arztebl.2008.0567
[10] de Costa A. The appendix-mucosal immunity and tolerance in the gut: consequences for the syndromes of appendicitis and its epidemiology. ANZ J Surg. 2022 Apr;92(4):653-60. https://doi.org/10.1111/ans.17522
[11] Soltani S, Kesheh MM, Siri G, Faramarzi S, Shahbahrami R, Didehdar M, et al. The role of viruses in human acute
appendicitis: a systematic literature review. Int J Colorectal Dis. 2023 Apr 18;38(1):102. https://doi.org/10.1007/s00384-023-04391-z
[12] Ziebold C, von Kries R, Lang R, Weigl J, Schmitt HJ. Severe complications of varicella in previously healthy children in Germany: a 1-year survey. Pediatrics. 2001 Nov;108(5):E79. https://doi.org/10.1542/peds.108.5.e79
[13] Alder AC, Fomby TB, Woodward WA, Haley RW, Sarosi G, Livingston EH. Association of viral infection and appendicitis. Arch Surg. 2010 Jan;145(1):63-71. https://doi.org/10.1001/archsurg.2009.250
[14] Pogorelić Z, Biocić M, Jurić I, Milunović KP, Mrklić I. Acute appendicitis as a complication of varicella. Acta
Medica (Hradec Kralove). 2012;55(3):150-2. https://doi.org/10.14712/18059694.2015.55
[15] Smedegaard LM, Christiansen CB, Melchior LC, Poulsen A. Appendicitis Caused by Primary Varicella Zoster Virus
Infection in a Child with DiGeorge Syndrome. Case Rep Pediatr. 2017;2017:6708046. https://doi.org/10.1155/2017/6708046
[16] Kilic S, Atici A, Kilincer A, Ozciftci G. A rare presentation of varicella: acute appendicitis. HK J Paediatr (New Series).
2017;22(3):179-80.
[17] Moon HM, Park BS, Moon DJ. Diagnostic Value of C-reactive Protein in Complicated Appendicitis. J Korean Soc
Coloproctol. 2011 Jun;27(3):122-6. https://doi.org/10.3393/jksc.2011.27.3.122
[18] Fennell J, Territo HM, Telt N, Wrotniak BH, Kozielski R, Pape E et al. The Association Between C-Reactive Protein Levels and Pediatric Appendicitis Score and the Severity of Appendicitis in Children. J Emerg Med. 2024 Apr;66(4):e508-e15. https://doi.org/10.1016/j.jemermed.2023.11.016
[19] Glass CC, Rangel SJ. Overview and diagnosis of acute appendicitis in children. Semin Pediatr Surg. 2016 Aug;25(4):198-203. https://doi.org/10.1053/j.sempedsurg.2016.05.001
[20] Jumah S, Wester T. Non-operative management of acute appendicitis in children. Pediatr Surg Int. 2022 Nov 28;39(1):11. https://doi.org/10.1007/s00383-022-05284-y
| Files | ||
| Issue | Vol 10 No 3 (2025): May-June | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v10i3.20308 | |
| Keywords | ||
| Varicella Acute appendicitis Pediatrics | ||
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How to Cite
1.
Mohammadi MS, Ghazizadeh Esslami G, Dehghan AH, Tabatabaei MS. The Association between Varicella and Acute Appendicitis: A Rare Case Report and Literature Review. CRCP. 2025;10(3):98-102.
