A rare case of acute liver failure due to disseminated Varicella-Zoster Virus (VZV) infection

Varicella zoster virus (VZV) is a human alpha herpes virus that typically manifests in humans with two distinct cutaneous phenotypes: primary varicella, or chickenpox, and secondary reactivation, or Shingles, after establishing latency in the cranial and dorsal root ganglia. VZV infection can present with rarer manifestations including encephalitis, pneumonia, hepatitis, myocarditis, and nephritis. Immunocompromised populations are at the greatest risk for cutaneous and visceral dissemination. The progression of VZV hepatitis to acute liver failure is exceedingly rare, with very few published cases in the literature. In the following case, we report the initial presentation and clinical manifestations of an immunocompromised patient who presented with vesicular skin findings and elevated transaminases, who quickly progressed to acute liver failure, and had postmortem findings of disseminated VZV infection.