To The Editors:
The urinary hallmarks of glomerulonephritis, proteinuria, hematuria and red blood cell casts, have been occasionally reported in patients with varicella.1-3 Secondary bacterial skin infection resulting from Streptococcus pyogenes or varicella per se could account for this benign complication of varicella.1-3 We report a pediatric patient with acute glomerulonephritis linked with herpes zoster.
A boy had had varicella at the age of 6 weeks. At the age of 6.5 years he underwent elective surgical repair of an obstructive megaureter. Clusters of vesicular lesions in dermatomes L1 and L2 on the right trunk were noted 7 days after surgery. They had been preceded by localized pain and low grade fever. Herpes zoster was diagnosed. Urinalysis, which was normal before and immediately after surgery, showed hematuria, red blood cell casts and significant proteinuria of 28 mg/[m2 · h] (normal up to 4 mg/[m2 · h]) but with no bacteriuria. Blood pressure (116/63 mm Hg) and circulating creatinine (65 μmol/l), protein (74 g/l) and complement C3 (1.53 g/l) were normal. Renal Doppler ultrasound examination failed to reveal findings consistent with renal vein thrombosis. The subsequent clinical course was uneventful. Urinalysis was normal 45 days after surgery.
The development of glomerulonephritis mediated by anti-glomerular basement membrane antibodies was reported in a man with herpes zoster that followed treatment for Hodgkin's disease.4 Nevertheless the role of zoster infection remained unclear because of the known nephritogenic potential of solid lymphoid tissues.4 Although association of herpes zoster and acute glomerulonephritis does not unequivocally signify causation, it is tempting to assume that zoster infection was possibly the triggering event in the development of acute glomerulonephritis in our patient.
A. Rossetti, M.D.; M. Tönz, M.D.; Mario G. Bianchetti, M.D.
Department of Pediatric Surgery (AR, TM)
Division of Pediatric Nephrology (MGB)
University of Bern
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as a complication of varicella. JAMA 1967;202:113-5.
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associated with varicella infection. Am J Med 1968;44:489-92.
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with Hodgkin's disease and herpes zoster. Arch Pathol Lab Med 1978;102:527-9.