Fatal disseminated visceral varicella zoster virus infection in a renal transplant recipient

Abstract

We report a case of fatal disseminated varicella zoster virus (VZV) with delayed–onset rash in a 66‐year‐old female more than 2 years following uncomplicated deceased donor renal transplantation. Whilst on a stable regimen of maintenance immunosuppression, the patient presented with chest and abdominal pain with concomitant hepatitis and pancreatitis. After pursuing multiple other potential causes of her symptoms, the correct diagnosis of VZV was only suspected after the development of a widespread vesicular rash—11 days after her initial symptoms. Despite antiviral therapy and inotropic support in the intensive care unit, the patient died. Simultaneous VZV hepatitis and pancreatitis in solid organ transplant recipients is uncommon. The new inactivated VZV vaccines have the potential to prevent post‐transplant infections, with promising early clinical data on safety and efficacy in renal transplant recipients. VZV is an important preventable infection that should be considered in immunocompromised patients, even in the absence of rash.

Impfen bei Immundefizienz

“…Vor Organtransplantation: Eine Infektion mit dem VZV kann zu Transplantatversagen, schwerwiegenden Komplikationen bis hin zu tödlichen Verläufen führen [1,52,133,153,155,208]. Die STIKO empfiehlt aus diesem Grund, alle seronegativen Personen vor Organtransplantation zweimalig gegen Varizellen zu impfen (Mindestabstand zwischen den Impfungen: 4 Wochen).…”

Disseminated varicella-zoster virus infection in an aplastic anemia- paroxysmal nocturnal hemoglobinuria syndrome patient: A case report

“…Adults and immunocompromised patients are more prone to severe infections than healthy children ( Gershon et al, 2015 ; Nagel and Gilden, 2014 ). Severe or even fatal chickenpox, moreover, often occurs in patients with impaired immune function due to diseases or drugs, such as corticosteroids or cancer chemotherapy ( Petrun et al., 2015 ; Lewis et al., 2017 ; Kennedy and Gershon, 2018 ; Loftus et al., 2019 ; Pannu and Manikandan, 2019 ).…”

Fatal visceral disseminated varicella-zoster virus infection in a renal transplant recipient: A case report

“…He was diagnosed with visceral disseminated VZV and received intravenous acyclovir (10 mg/kg twice daily) only after developing a widespread vesicular rash 11 d following the onset of chest and back pain. Despite supportive care and antiviral therapy, the patient died after 6 d in the ICU[ 6 ]. Another case involved a renal transplant recipient in India who presented after 7 d of severe epigastric pain and 4 d of multiple vesiculopapular rashes over the entire body.…”