Varicella in immunocompromised children. Incidence of abdominal pain and organ involvement.

The medical records of 31 immunocompromised patients who experienced varicella infections from 1975 to 1982 were reviewed. Fifteen of these patients had visceral involvement. In these 15 patients, two clinical patterns of progression were noted: (1) Eleven patients with life-threatening involvement experienced hepatitis (n = 11), pneumonitis (n = 11), abdominal pain (n = 11), encephalopathy (n = 10), coagulopathy (n = 10), inappropriate antidiuretic hormone (ADH) syndrome (n = 10), back pain or myalgia (n = 5), and myocarditis (n = 1). Seven of these patients survived, all without sequelae. (2) Four patients with a milder course experienced subclinical hepatitis (n = 4), mild pneumonitis (n = 4), postinfectious encephalitis (n = 1), and septic arthritis associated with disseminated intravascular coagulopathy (n = 1). All four of these patients recovered completely. In patients with severe involvement, intense abdominal pain was frequently the first sign of dissemination. Abdominal pain and inappropriate ADH syndrome were unexplained and have not been previously described in progressive varicella. A predictable pattern of organ involvement enabled starting therapy early and resulted in the survival of 11 of 15 patients.