Varapericarditis

Varapericarditis refers to pericardial inflammation associated with infection by varicella-zoster virus (VZV), the agent responsible for chickenpox and shingles. It may occur during primary varicella infection or after reactivation of latent VZV as herpes zoster. Varapericarditis is a recognized cause of acute viral pericarditis and may present alongside or shortly after cutaneous varicella or zoster manifestations, though it can also occur with minimal or no skin findings.

The pathophysiology involves inflammation of the pericardial sac due to direct viral invasion and/or immune-mediated mechanisms triggered by VZV. The condition can affect individuals of any age, though the clinical context often depends on whether an active varicella or zoster infection is present.

Clinical features typically include sharp, pleuritic chest pain that may improve when sitting up or leaning forward, shortness of breath, fever, and a pericardial knock or friction rub on examination. Pericardial effusion can occur, and rarely tamponade. When herpes zoster skin lesions are present, the pericarditis may coincide with widespread rash; however, pericardial disease can also occur in the absence of a cutaneous eruption.

Diagnosis rests on the clinical context supported by electrocardiography, which may show diffuse ST-segment elevations and PR-segment depressions, and by echocardiography to assess for effusion. Inflammatory markers such as CRP or ESR are commonly elevated. Virological confirmation via VZV testing of blood or pericardial fluid is infrequently necessary but can be considered in atypical cases.

Treatment is largely supportive and aimed at reducing inflammation: nonsteroidal anti-inflammatory drugs or aspirin, and colchicine to lower recurrence risk. Antiviral therapy (e.g., acyclovir) is considered when active varicella or zoster infection is present or in high-risk individuals. Most cases resolve with treatment, though myocarditis or recurrent pericarditis can occur. Vaccination against varicella and zoster reduces the incidence of VZV-related complications.