Fatal varicella with liver necrosis after kidney transplantation

A young adult died in the early phase of varicella with massive liver necrosis. Severe abdominal pain was the predominant complaint. Liver necrosis is a characteristic, albeit uncommon, but usually fatal complication of varicella in the compromised host and is heralded by severe abdominal pain. Children and young adults should be screened by history or a sensitive antibody test for immunity to varicella before transplantation. After transplantation susceptible patients should receive passive immunization with zoster hyperimmune globulin in case of exposure and early therapy with acyclovir in case of infection. Vaccination of susceptible patients with an attenuated live virus vaccine before transplantation has promise for reducing the risk of varicella after transplantation.