Fatal varicella hepatitis in an asthmatic adult after short-term corticosteroid treatment

Hyvernat, H.; Roger, Pierre‐Marie; Pereira, Cláudia da Silva; Saint-Paul, M; Vandenbos, F.; Bernardin, G.

doi:10.1016/j.ejim.2004.11.018

Cited by 10 publications

(9 citation statements)

References 6 publications

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“…In immunocompromised patients, the disease type at reoccurrence is not limited to herpes zoster; VZV can also present as varicella. Steroid administration generally increases the frequency and severity of VZV infection [12], and steroid administration of 61 days or longer is a risk factor. Women are reported to have a 25% higher incidence than men [11], but the reason for this sex-related difference is unknown.…”

Section: Discussionmentioning

confidence: 99%

Successful management of visceral disseminated varicella zoster virus infection during treatment of membranous nephropathy: a case report

et al. 2019

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Background Visceral disseminated varicella zoster virus (VDVZV) infection is a rare disease with a high mortality rate (55%) in immunocompromised patients, but it is not yet widely recognized in the field of nephrology. We report a case of VDVZV contracted during immunosuppressive therapy for membranous nephropathy. Case presentation A 36-year-old woman was diagnosed with membranous nephropathy and was being treated with immunosuppressive therapy consisting of 60 mg/day prednisolone, 150 mg/day mizoribine, and 150 mg/day cyclosporine. Nephrosis eased; therefore, the prednisolone dosage was reduced. However, 50 days after starting immunosuppressive therapy, the patient suddenly developed strong and spontaneous abdominal pain, predominantly in the epigastric area, without muscular guarding or rebound tenderness. Blood data indicated neutrophil-dominant elevated white blood cell count, reduced platelet count, elevated transaminase and lactate dehydrogenase, slightly increased C-reactive protein, and enhanced coagulability. Abdominal computed tomography revealed a mildly increased enhancement around the root of the superior mesenteric artery with no perforation, intestinal obstruction, or thrombosis. The cause of the abdominal pain was unknown, so the patient was carefully monitored and antibiotic agents and opioid analgesics administered. The following day, blisters appeared on the patient’s skin, which were diagnosed as varicella. There was a marked increase in the blood concentration of VZV-DNA; therefore, the cause of the abdominal pain was diagnosed as VDVZV. Treatment with acyclovir and immunoglobulin was immediately started, and the immunosuppressive therapy dose reduced. The abdominal pain resolved rapidly, and the patient was discharged 1 week after symptom onset. Discussions and conclusions This patient was VZV-IgG positive, but developed VDVZV due to reinfection. Abdominal pain due to VDVZV precedes the skin rash, which makes it difficult to diagnose before the appearance of the rash, but measuring the VZV-DNA concentration in the blood may be effective. Saving the patient’s life requires urgent administration of sufficient doses of acyclovir and reduced immunosuppressive therapy.

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Section: Discussionmentioning

confidence: 99%

Successful management of visceral disseminated varicella zoster virus infection during treatment of membranous nephropathy: a case report

et al. 2019

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“…To our knowledge, this is the first report of fulminant varicella hepatitis in an adult with a successful outcome following liver transplantation and perioperative acyclovir. Most of the cases described occurred in patients who were immunocompromised because of bone marrow or solid organ transplantation,4 human immunodeficiency virus infection,6 acute lymphoblastic leukemia,5 or corticosteroid therapy (even for a short period) with systemic, inhaled, or intranasal administration 1, 2, 7. In immunocompetent patients, antigenic variations of gE glycoprotein may have accounted for the visceral dissemination of VZV in some described cases, as suggested by Natoli et al9 In our present case, sequence analysis of gE did not reveal any mutation in comparison with the wild‐type reference strain.…”

Section: Discussionmentioning

confidence: 99%

“…Although varicella is frequently associated with mild hepatitis, fulminant liver failure is rare 1. Only a few cases have been reported; these mainly occurred during a primary infection in patients with impaired immunity 1–7. We report here on the first case of an adult patient who underwent liver transplantation for fulminant liver failure related to a primary varicella infection.…”

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confidence: 97%

Chickenpox-associated fulminant hepatitis that led to liver transplantation in a 63-year-old woman

et al. 2008

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A 63-year-old woman treated with prednisone for sinusitis developed fulminant liver failure due to a clinically unsuspected primary varicella zoster virus infection. The diagnosis of herpetic hepatitis was made from a liver biopsy, and varicella zoster virus viremia was detected by polymerase chain reaction. She was treated successfully with transplantation and perioperative administration of acyclovir. Liver Transpl 14:1309-1312, 2008. © 2008 AASLD. Received November 27, 2007 accepted February 25, 2008. Varicella or "chickenpox" is a very common and usually benign childhood disease due to a primary infection by the varicella zoster virus (VZV), which belongs to the alpha herpesvirus family. Up to 95% of the population is immunized during childhood, so varicella in adulthood is rare. Adulthood and immunodepression are predisposing factors for visceral involvement, with interstitial pneumonitis and meningoencephalitis being the most common visceral complications. Although varicella is frequently associated with mild hepatitis, fulminant liver failure is rare.1 Only a few cases have been reported; these mainly occurred during a primary infection in patients with impaired immunity. [1][2][3][4][5][6][7] We report here on the first case of an adult patient who underwent liver transplantation for fulminant liver failure related to a primary varicella infection. CASE REPORTOn July 23, 2005, a 63-year-old woman was admitted to a regional hospital for severe abdominal pain in the right lower quadrant with no fever. She had a history of asthma since the age of 20, requiring inhaled corticosteroids and bronchodilators. Ten days previously, she had suffered from sinusitis, which was treated with prednisone and pristinamycin for 7 days. At the time of admission, physical findings were not remarkable. Alanine aminotransferase and aspartate aminotransferase levels were 580 and 435 U/L respectively, with a normal prothrombin time and a white blood cell count (WBC) of 11 ϫ 10 3 /mm 3 . Abdominal ultrasound and chest X-ray findings were normal. Skin lesions were absent on the first day of admission. On day 2, a 2-cm-diameter cluster of clear vesicles on an erythematous base was noted on the right-hand surface of the abdomen, with no associated pruritus. This initial lesion was thought to be eczema. On day 3, this initial lesion progressed to pustules, and similar circular lesions were noted in the axillary cavities. In addition, several vesicles on an erythematous base appeared on the trunk. These lesions were considered to be impetigo, and local disinfection with eosin was performed, which impaired any further assessment of their course. On July 26, the patient's liver function worsened, and she was transferred to our intensive care unit for fulminant hepatitis. On admission, a clinical examination did Abbreviations: CMV, cytomegalovirus; HSV, herpes simplex virus; PCR, polymerase chain reaction; VZV, varicella zoster virus; WBC, white blood cell count. Address reprint requests to Anne-Marie Roque-Afonso,

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“…However, varicella cases marked by liver damage are frequently fatal. 10 In these cases, the patients are often immunocompromised due to other disease or therapy. Several fatal cases of children suffering from acute lymphoblastic leukemia and treated with corticosteroids have been described.…”

Section: Other Similar and Contrasting Cases In The Literaturementioning

confidence: 99%

“…Patients who have been immunosuppressed due to corticosteroid therapy (including short therapeutic courses), cytostatic or other immunosuppressive drugs are at increased risk during VZV infection. [9][10][11] Disseminated varicella is more common in children with malignancies, particularly those in whom therapy is initiated during the varicella incubation period. 12,13 Here we describe a case of an acute hepatic failure and death associated with primary infection caused by a wild-type clade 4 VZV strain in an adult patient treated with corticosteroids for suspected multiple sclerosis (MS).…”

Section: Why This Case Is Importantmentioning

confidence: 99%

Fulminant hepatitis and death associated with disseminated varicella in an immunocompromised adult from the Czech Republic caused by a wild-type clade 4 varicella-zoster virus strain

Plíšek

Plíšková

Boštíková

et al. 2011

Journal of Clinical Virology

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Fatal varicella hepatitis in an asthmatic adult after short-term corticosteroid treatment

Cited by 10 publications

References 6 publications

Successful management of visceral disseminated varicella zoster virus infection during treatment of membranous nephropathy: a case report

Successful management of visceral disseminated varicella zoster virus infection during treatment of membranous nephropathy: a case report

Chickenpox-associated fulminant hepatitis that led to liver transplantation in a 63-year-old woman

Fulminant hepatitis and death associated with disseminated varicella in an immunocompromised adult from the Czech Republic caused by a wild-type clade 4 varicella-zoster virus strain

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