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Abstract
There are several causes of infectious and non-infectious urticaria recognized. Reports described association with streptococcus, mycoplasma pneumoniae, parvovirus B19, enterovirus, hepatitis A or B and plasmodium falciparum and urticaria. Norovirus is a recognised albeit rare cause of urticaria. Leiste A et al. have published two cases identified on Norovirus-related urticaria in adult patients. There are no cases yet described in paediatric population on Norovirus related urticaria. Following is the unique case of norovirus related urticaria in paediatric patient.
A two year old, male patient was admitted to the paediatric ward with a sudden episode of generalised florid rash proceeding with multiple episodes of diarrhoea and vomiting. There was no involvement of mucous membranes and joints. The rash was erythematous, with widespread wheals spreading all over the body associated with intensive pruritus which left excoriation marks. The rash and pruritus was subsided with a course of antihistamines. There was no pyrexia documented during the episode and there was no history of atopies. He attends crèche and there was recent acute gastroenteritis in a crèche attendee. On physical examination, the only positive finding was mild to moderate dehydration with no evidence of shock thus intravenous fluid was commenced. His blood investigations done included full blood count, C-reactive protein, renal profile, blood cultures, extended viral panel on nasal swab were normal though stool culture was positive for norovirus. The rash was subsided completely within few hours. Patient was discharged home the following day.
Discussion Noroviruses are genetically diverse group of single-stranded positive -sense RNA, non-enveloped virus belonging to the family Caliciviridea. It primarily causes gastrointestinal symptoms. Patients usually feel very unwell with nausea, vomiting and diarrhoea. A headache and fever may occur. Norovirus is very contagious. It is mainly transmitted by direct person to person contact or through contaminated food/water. It is found in all age group and more prevalent in the winter months. Complications may include dehydration. The incubation period is up to 3 days. There were two cases described previously in adult patient which had an association with urticaria. Comparing the reports from adult’s patients, the evidence strongly suggests association between norovirus and urticaria. There is need for further studies and case reports to justify the association.