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12 August 2020: Articles

Atypical Reactivation of Varicella Zoster Virus Associated with Pancreatitis in a Heart Transplant Patient

Unusual clinical course, Challenging differential diagnosis, Educational Purpose (only if useful for a systematic review or synthesis)

Christine Shieh B* , Ashley Barnes B , Drew M. Johnson B , Ilya M. Danelich B , Preethi Pirlamarla B , Rene Alvarez B , Howard Massey B , Mahek Shah A

DOI: 10.12659/AJCR.923969

Am J Case Rep 2020; 21:e923969

Table 1. A review of disseminated VZV cases predominantly reported in renal transplant patients in the past.

StudyPatientsOutcomesConclusions
Metanalysis 1985–2011Rommelaere et al. []10 56 adult renal transplant patients with disseminated VZVMortality rate: 47% before 1995 and 17% after 1995Complications: 2/3 with disseminated intravascular coagulationDisseminated VZV is life threatening but the mortality rate has decreased since 1995Seropositive VZV patients with disseminated infection can still have fatal outcome
Single center retrospective studyMustapic et al. []11 40 renal transplant patients, 5 of which had disseminated VZVNo deathsComplications: 7 with cutaneous scarring, 2 with post-herpetic neuralgia, and 5 relapsed.Immunosuppression was decreased for the relapsed patientsFrequency and intensity of VZV infections is associated with degree of immunosuppression, particularly MMFHigh-dose acyclovir and reduction of immunosuppression is important for treatment
Retrospective study 2003–2013Chitasombat et al. []12 22 renal transplant patients with disseminated VZVNo deathsAll were treated with systemic acyclovir for 3–31 days.Immunosuppression reduced for 59% of patientsIncidence of disseminated VZV post kidney transplant is lowTreatment with IV acyclovir and reduction of immunosuppression provides a favorable outcome in resource limited environments
Single center case report series Fehr et al. []13 4 renal transplant patients with disseminated VZVNo deathsComplications: hepatitis, pneumonitis, disseminated intravascular coagulationFurther literature search reveals a high mortality rate of 34% but this has decreased in the recent yearsHigh-dose acyclovir is the drug of choice
VZV – varicella zoster virus.

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923