search text   Advanced Search

Post-publication Peer Reviews to:

ELECTRONIC ARTICLE: June M. Caruso, Glenn A. Tung, and William D. Brown Central Nervous System and Renal Vasculitis Associated With Primary Varicella Infection in a Child Pediatrics 2001; 107: e9 [Abstract] [Full text] [PDF]

P3Rs: Submit a response to this article

P³Rs published:

Varicella-Zoster Virus and pediatric stroke syndromes

leslie Barton   (22 January 2001)

reply from author

William Brown   (23 January 2001)

correction

William Brown   (4 February 2001)

Varicella-Zoster Virus and pediatric stroke syndromes 22 January 2001
leslie Barton, MD; Prof of Pediatrics Univ of AZ School of Med; Dept of Peds Send letter to journal: Re: Varicella-Zoster Virus and pediatric stroke syndromes llb{at}peds.arizona.edu leslie Barton	I read with great interest the article on VZV-associated vasculitis in an immunocompetent child. Although this is, thankfully, an uncommon occurrence in healthy children, it has been previously reported. I would refer the authors to the Pediatric Infectious Disease J 2000;19:648 and 653 as well as to the October issue of AAP Grand Rounds. The paper nevertheless reinforces the importance of universal childhood immunization with the varicella vaccine.
reply from author 23 January 2001
William Brown, department of neurology and pediatrics rhode island hospital/brown university Send letter to journal: Re: reply from author wdbrown{at}brown.edu William Brown	We wish to thank Dr Barton for directing our attention to the tabulation of varicella-zoster related stroke syndromes in children by Moriuchi and Rodriguez.(Moriuchi H Rodriguez W Role of varicella-zoster virus in stroke syndromes Pediatr Infect Dise J 20 19(7):648-53). In this citation, there are two patients listed from another reference with clinical presentations similar in time course to ours. These two cases were identified by means of a survey given to parents of children who experienced ischemic stroke, the "aim of which was to explore functional outcome."(Ganesan V Kirkham FJ Mechanisms of ischaemic stroke after chickenpox Arch Dis Child 1997 76:522-5). In the first of these cases, a 3.5 year old boy became hemiparetic 1 week after varicella onset, and was evaluated six months after his acute illness by MRA, which showed a bilateral moyamoya pattern. No information about his clinical course or assessment during the acute illness was offered. In the second case, a six year old boy presented with seizures and homonymous hemianopia a week after developing chickenpox. He had an initial deficiency of protein S associated with elevated antivaricella serum IgM antibodies; neuroimging by computed tomography showed an occipital infarction. Neither patient was reported to have any vascular involvement outside of the brain, in contrast to our patient with renal infarction and spinal cord dysfunction. An additional patient reported by Moros-Pena et al (Moros-Pena M et al Cerebral ischemia following varicella Rev Neurol 2000 31(2):122-5) presented with hemiparesis 8 days after varicella onset. This report from July 2000 appeared after our case was submitted to Pediatrics, at about the same time the article by Moriuchi appeared. The documentation of systemic vasculitis involving blood vessels outside the nervous system in an immunocompetent child with primary varicella infection has not been submitted previously as we have stated. Direct neurovascular imaging evidence of large blood vessel pathology in this setting has not been submitted previously as we stated. Other pathophysiologic mechanisms may have been at play in the the two cases to which Dr Barton referred, and were excluded as potential causes in our patient. The rare complication of primary varicella vasculitis is life threatening, and must be considered in any child who presents with altered mental status or focal neurological deficits in the setting of an acute varicella infection. We agree with Dr Barton that our case and others like it highlight the need for universal varicella vaccination. William Brown MD Division of Pediatric Neurology Hasbro Childrens Hospital/Brown University Provience RI 02903
correction 4 February 2001
William Brown, physician brown university Send letter to journal: Re: correction wdbrown{at}brown.edu William Brown	the last sentence of the second to last paragraph of the discussion has been modified from the submitted version and should read: The incidence of serious neurologic injury as a consequence of primary varicella infection can be expected to DECREASE with widespread use of this vaccine.

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2008 American Academy of Pediatrics. All rights reserved.