Acute pancreatitis in immunocompromised patients: beware of varicella zoster virus primo‐infection

Picod, Adrien; Corre, Elise; Maury, Éric; Duriez, P.; Hoyeau, Nadia; Coppo, Paul

doi:10.1002/ccr3.1053

Cited by 5 publications

(5 citation statements)

References 6 publications

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“…However, signs of a varicella infection were presented prior to the onset of their abdominal symptoms and subsequent pancreatitis diagnosis. There have been some reports suggesting the vesicular formation indicative of an underlying varicella infection could be delayed or absent in this patient population [20]. However, with our case, antibody testing for varicella was negative at admission of our patient and polymerase chain reaction (PCR) was only possible after the eruption of a rash.…”

Section: Discussionmentioning

confidence: 52%

“…This makes it more likely that the cause of our patient's acute pancreatitis was more likely due to her recent chemotherapy, rather than an infection. Regardless, immunocompromised patients with herpes zoster positive serology should prompt suspicion for visceral seeding [3,20]. Patients with any history of varicella and are undergoing treatment that could put them in an immunocompromised state should receive valacyclovir prophylaxis [20].…”

Section: Discussionmentioning

confidence: 99%

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Acute Pancreatitis Induced by Polatuzumab-Vedotin-Piiq in Combination With Bendamustine and Rituximab for Diffuse Large B-Cell Lymphoma

Anderson

Shehata

Singh

et al. 2020

Cureus

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While alcohol and gallstones have been considered the most common causes of pancreatitis, we investigate two uncommon etiologies such as drug-induced and viral-induced. Pancreatitis, an inflammatory process, can lead to many complicated outcomes such as acute respiratory failure, sepsis, and death. Examining drug-induced pancreatitis poses a large challenge for physicians as majority of the data is extrapolated from case reports. This is made even more difficult for patients who are on large chemotherapeutic regimens which include multitude of drugs and various side effects. Besides patient medication regimens, other etiologies of pancreatitis must be ruled out such as viruses. We examine a case of a 48-year-old female undergoing treatment for diffuse large B-cell lymphoma with various chemotherapeutic agents and positive cultures for varicella zoster virus (VZV) presenting with diffuse epigastric abdominal pain.

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Section: Discussionmentioning

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Acute Pancreatitis Induced by Polatuzumab-Vedotin-Piiq in Combination With Bendamustine and Rituximab for Diffuse Large B-Cell Lymphoma

Anderson

Shehata

Singh

et al. 2020

Cureus

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“…Delayed onset of rash compared to the first symptoms of acute pancreatitis has been reported elsewhere in cases of VZV infection in immunocompromised patients. [ 3 , 5 , 6 ]…”

Section: Discussionmentioning

confidence: 99%

“…Given the theoretical contraindication to live attenuated VZV vaccination in immunocompromised patients, some authors have proposed generalized prophylaxis with valaciclovir in this category of patients not immunized against VZV. [ 5 ] Vaccination could nevertheless be proposed, taking care to administer it before starting chemotherapy, if there is no history of varicella and if serology is negative. In addition to the live attenuated vaccine (Zostavax), a more effective recombinant subunit adjuvant vaccine (Shingrix) is already available in some countries.…”

Section: Discussionmentioning

confidence: 99%

Primary varicella-zoster virus infection of the immunocompromised associated with acute pancreatitis and hemophagocytic lymphohistiocytosis

et al. 2021

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Rationale: Primary varicella-zoster virus (VZV) infection may be associated with hemophagocytic lymphohistiocytosis (HLH), as well as with acute pancreatitis. However, there is few data concerning the evolution and the optimal treatment of these rare associations. Patient concerns: A 57-year-old immunocompromised woman, who was treated for chronic lymphocytic leukemia 3 years prior to admission, was hospitalized with abdominal pain revealing severe acute pancreatitis. The day after admission, a pruritic rash appeared on her face, trunk, and limbs, sparing the palmoplantar regions. At the same time, fever, thrombocytopenia (27 × 10 9 /L), major hyperferritinemia (11,063 μg/mL), hypertriglyceridemia (2.56 mmol/L) and elevated lactate dehydrogenase levels (1441 IU/L) suggested HLH. Diagnosis: The diagnosis of chickenpox (varicella) was established. Primary VZV infection was then confirmed: cutaneous and plasma VZV polymerase chain reactions were positives, VZV serology was negative for IgG. Interventions: Treatment with aciclovir was started intravenously after the onset of the rash, for a total of 10 days. A 48-h surveillance in intensive care was carried out. Outcomes: Acute pancreatitis and biological abnormalities evolved favorably under aciclovir. Platelet count was normalized 6 days after admission to hospital. Lessons: A favorable outcome of primary VZV infection associated with severe acute pancreatitis and probable HLH in an immunocompromised patient is possible with aciclovir alone.

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“…However, the immunocompromised status of patients can indeed play a role in the development and severity of viral-induced acute pancreatitis. Immunocompromised individuals, such as those with weakened immune systems due to conditions like varicella zoster virus/cytomegalovirus, organ transplantation, or immunosuppressive therapy, may be more susceptible to viral infections ( Oku et al, 2005 ; Picod et al, 2017 ; Ahmad et al, 2021 ). Viruses that can cause pancreatitis may take advantage of the compromised immune response, leading to more severe and prolonged episodes of inflammation in the pancreas.…”

Section: Mechanism Of Viral Associated Pancreatitismentioning

confidence: 99%

Viral pancreatitis: research advances and mechanisms

Yu,

Wang,

Kong

2024

Front. Microbiol.

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Acute pancreatitis is caused by trypsinogen activation in acinar cells caused by various injury forms (gallstone, high triglycerides, alcohol, etc.). Viral pancreatitis is a clinically rare disease type, which is easily neglected by clinicians and causes serious adverse consequences. Viral pancreatitis involves the entry of viruses into pancreatic cells, triggering inflammation, immune response activation, and enzymatic autodigestion, leading to tissue damage and potential complications. At present, there are few available reports on viral pancreatitis, most of which are case reports. This review brings attention to clinicians by describing the incidence of viral pancreatitis to enhance clinical understanding and patient care.

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Acute pancreatitis in immunocompromised patients: beware of varicella zoster virus primo‐infection

Cited by 5 publications

References 6 publications

Acute Pancreatitis Induced by Polatuzumab-Vedotin-Piiq in Combination With Bendamustine and Rituximab for Diffuse Large B-Cell Lymphoma

Acute Pancreatitis Induced by Polatuzumab-Vedotin-Piiq in Combination With Bendamustine and Rituximab for Diffuse Large B-Cell Lymphoma

Primary varicella-zoster virus infection of the immunocompromised associated with acute pancreatitis and hemophagocytic lymphohistiocytosis

Viral pancreatitis: research advances and mechanisms

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