Hemorrhagic Varicella in a 41-Year-Old Woman with Evans Syndrome : Case Report

Abstract

Background: Varicella is an infection caused by the varicella-zoster virus (VZV) with symptoms
of an exanthematous vesicular rash and systemic symptoms. Hemorrhagic varicella commonly
seen in immunocompromised patients. Evans syndrome (ES) is an autoimmune with two or more
cytopenias,including autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP).
Case: 41-year-old woman complains of swelling filled with reddish fluid almost all over her
body,sometimes painful and accompanied by fever. Patient also experienced vaginal bleeding resulting
in anemia (Hb 8.8 g/DL) and thrombocytopenia (platelets 34,000/uL). Dermatological status of the
generalized,multiple hemorrhagic vesicles with an erythematous base,partially ruptured. Tzank test
revealed multinucleated giant cells. Patient suffered AIHA and received therapy with methylprednisolone
4 mg/day and mycophenolic acid 2x500 mg/day.
Conclusion: We report a case of hemorrhagic varicella in a 41-year-old woman with Evan’s syndrome
with concurrent features of AIHA and ITP. Dermatological status of the generalized, multiple
hemorrhagic vesicles with an erythematous base,some of ruptured with erosions. Tzank test revealed
multinucleated giant cells. Patient was treated with acyclovir 5x800 mg for 7 days,2% salicylic acid and
0.5% menthol applied every 12 hours and mupirocin 2% ointment applied twice a day on the erosion
area and clinical improvement was found after 17 days of therapy.