Cerebral Venous Thrombosis and Acute Pulmonary Embolism following Varicella Infection

Varicella infection is caused by varicella-zoster virus (VZV) and commonly presents as a self-limiting skin manifestation in children. VZV also causes cerebral arterial vasculopathy and antibody-mediated hypercoagulable states leading to thrombotic complications in children, although there are very few such reports in adults. Postulated causal factors include vasculitis, direct endothelial damage, or acquired protein S deficiency secondary to molecular mimicry. These induced autoantibodies to protein S could lead to acquired protein S deficiency and produce a hypercoagulable state causing venous sinus thrombosis. Here we report the case of a 26-year-old man who presented with cortical venous sinus thrombosis and acute pulmonary embolism following varicella infection. Both conditions responded to anticoagulation treatment. LEARNING POINTS: Varicella infection caused by varicella-zoster virus (VZV) can rarely present with thrombotic complications after a period of latency. Postulated causal factors include vasculitis, direct endothelial damage, and acquired protein S deficiency secondary to molecular mimicry. The prognosis of post-varicella thrombosis is good, but a prothrombotic screen after recovery to diagnose hereditary prothrombotic states is advisable.