12 August 2020
: Case report
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 Shieh1BCDEF*, Ashley Barnes1BD, Drew M. Johnson2B, Ilya M. Danelich3BE, Preethi Pirlamarla2B, Rene Alvarez2B, Howard Massey4B, Mahek Shah2ABCDEDOI: 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.
Study | Patients | Outcomes | Conclusions |
---|---|---|---|
Metanalysis 1985–2011Rommelaere et al. []10 | 56 adult renal transplant patients with disseminated VZV | Mortality rate: 47% before 1995 and 17% after 1995Complications: 2/3 with disseminated intravascular coagulation | Disseminated 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 VZV | No deathsComplications: 7 with cutaneous scarring, 2 with post-herpetic neuralgia, and 5 relapsed.Immunosuppression was decreased for the relapsed patients | Frequency 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 VZV | No deathsAll were treated with systemic acyclovir for 3–31 days.Immunosuppression reduced for 59% of patients | Incidence 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 VZV | No deathsComplications: hepatitis, pneumonitis, disseminated intravascular coagulation | Further 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. |