Acute urinary retention as a complication of primary varicella-zoster infection of childhood - a second reported case.

Correspondence Acute urinary retention as a complication of primary varicella-zoster infection of childhood – a second reported case To the Editor: We discuss the case of a child with acute urinary retention and constipation following primary varicella-zoster infection (chickenpox). To our knowledge, this unusual complication has only been reported once before. 1 An 8-year-old boy presented 2 days after developing urinary retention. Chickenpox had been diagnosed 2 weeks previously and treated with paracetamol and topical calamine lotion. There was no similar preceding history, trauma, use of anti-cholinergic medication, or other urinary or neurological signs or symptoms. The child was HIV-negative. He was fully ambulant, well hydrated and apyrexial. His urinary bladder was abdominally palpable and was catheterised at the referring hospital, draining clear urine. The trunk and extremities had healing primary varicella-zoster (chickenpox) skin lesions. No evidence of sacral or perineal shingles rash (secondary varicella-zoster infection) or neurological deficit was found. Urine dipstix, renal function tests, blood electrolytes, full blood count and C-reactive protein were normal. Lumbar puncture and serology for varicella-zoster virus were not done. After excluding urethral and bladder outlet obstruction, anti-cholinergic use, urinary tract or bladder infection and transverse myelitis, primary varicella-zoster virus-related urinary retention and constipation was tentatively diagnosed. He was admitted and given oral acyclovir (400 mg 8-hourly for 10 days) and laxatives. After 3 doses of acyclovir, the catheter was temporarily removed and the child gradually began to urinate and resumed passing stools. There were no further similar complaints after discharge. Informed consent for publication was obtained from the patient. The varicella-zoster virus is an exclusively human virus belonging to the Alphaherpesvirinae subfamily of the Herpesviridae. 2 It is neurotropic and very contagious, and is spread mostly by virus-filled respiratory droplets and, to a lesser degree, from skin lesions. 3 Varicella-zoster causes 2 distinct clinical syndromes: chickenpox/ varicella, the initial or primary infection of the host; and shingles/ zoster, corresponding to reactivation of latent infection. 2 In healthy children, chickenpox usually has no prodrome, is self-limiting, and is characterised by a distinct pruritic exanthum (macules progressing to papules and virus-rich vesicles before crusting), malaise and low-grade fever. Treatment is symptomatic. Once the self-limiting initial infection is contained by the immune system, the virus establishes itself within the spinal cord ganglia (dorsal root/sensory ganglia being the most common site) and becomes latent. Transport to the ganglia is thought to be via retrograde axonal transport (from …