Severe perianal shingles during azathioprine and budesonide treatment for Crohn's disease—preventable with zoster vaccine?

Elliott, Timothy R.; Miller, Charles F.; Macrae, Finlay

doi:10.1136/bcr-2016-216527

Cited by 4 publications

(3 citation statements)

References 11 publications

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“…Herpes zoster infection in patients with inflammatory bowel disease on immunosuppressive medications can be dangerous and may require cessation of the therapy. 5 Although in our patient, it was an incidental and isolated involvement of the hemorrhoidal surface by the VZV, we cannot predict further disease progression, necessitating close follow-up.…”

Section: Discussionmentioning

confidence: 63%

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A Rare Case of Varicella Zoster Infection in Hemorrhoids in a Patient With Inflammatory Bowel Disease

Siatecka,

Al-Awami,

Siddiqi

et al. 2024

The American Journal of Dermatopathology

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Hemorrhoids are normal anatomical structures in the anus. When symptomatic, they prompt medical attention due to pain, rectal bleeding, and discomfort. Treatment includes dietary modifications, rubber band ligations, sclerotherapy, cryotherapy, or hemorrhoidectomy. Histologic examination is important to rule out incidental findings, such as perianal intraepithelial neoplasia, anal carcinoma, melanoma, or coexisting infections. Special attention should be given when patient is immunocompromised. We present a case of a 41-year-old man with a history of ulcerative colitis on adalimumab who presented with anal lesions. He was diagnosed with hemorrhoids and surgically treated. Microscopic examination confirmed the diagnosis of hemorrhoids. However, foci of epithelium with viral cytopathic effects were noted. A varicella zoster virus (VZV)-specific immunostain was positive in the areas of interest confirming the diagnosis of the VZV infection limited to the hemorrhoids. Combined herpes simplex virus type 1 and 2 (HSV 1 and HSV 2) immunostain was also performed and was negative. Anal herpes has been widely described in the literature, particularly in immunocompromised patients. However, isolated VZV infection in hemorrhoids to the best of our knowledge has never been reported.

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Section: Discussionmentioning

confidence: 63%

“…4 Perianal shingles has been further described. 5,6 Other rare sites of involvement include lungs, brain, cerebellum, spinal cord, and retina. 7 Interestingly, to the best of our knowledge, isolated VZV infection in the hemorrhoids has never been reported.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of Varicella Zoster Infection in Hemorrhoids in a Patient With Inflammatory Bowel Disease

Siatecka,

Al-Awami,

Siddiqi

et al. 2024

The American Journal of Dermatopathology

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“…Azathioprine is one of the most widely used immunosuppressants for various illnesses, such as inflammatory bowel disease, autoimmune diseases, and post-transplant organ rejection. Although it is not a very strong immunosuppressant, cases of atypical HSV and herpes zoster infections have been reported in patients on azathioprine therapy [12,13]. A prospective study by Seksik et al also reported a significantly increased risk of HSV infections with azathioprine in inflammatory bowel disease (IBD) patients [14].…”

Section: Discussionmentioning

confidence: 99%

Hypertrophic Perianal Herpes Mimicking Squamous Cell Cancer: A Case Report and a Review of the Literature

Singh¹,

Tyagi²,

Khanduri³

et al. 2022

Cureus

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Clinical practice frequently involves the discovery of perineal lesions. The human papillomavirus, molluscum contagiosum, and herpes simplex virus are to blame for the majority of these anogenital lesions. In the majority of cases, these lesions may be identified by their distinctive appearance. It is challenging to make a clinical diagnosis in immunocompromised people since these lesions might be large and have uncommon appearances. Verrucous perianal herpes is a rare type of herpes that resembles squamous cell carcinoma in gross appearance. We present a case of a 71-year-old man on azathioprine, an immunosuppressive drug for autoimmune pancreatitis, who developed a perianal lesion resembling squamous cell carcinoma. Excisional biopsy revealed a benign ulcerative lesion with herpetic inclusions. The patient received antiviral treatment, and the perianal wound completely healed. He developed a similar lesion in the perineum at one year follow up, which was successfully treated with oral and topical antivirals.

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Clinical characteristics and prognosis of non-APAP drug-induced acute liver failure: a large multicenter cohort study

Han,

Huang,

Chen

et al. 2023

Hepatol Int

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Background There is growing recognition of natural history, complications, and outcomes of patients who develop non-acetaminophen (APAP) drug-induced acute liver failure (ALF). To clarify high-risk factors and develop a nomogram model to predict transplant-free survival (TFS) in patients with non-APAP drug-induced ALF. Methods Patients with non-APAP drug-induced ALF from 5 participating centers were retrospectively analyzed. The primary endpoint was 21-day TFS. Total sample size was 482 patients. Results Regarding causative agents, the most common implicated drugs were herbal and dietary supplements (HDS) (57.0%). The hepatocellular type (R ≥ 5) was the main liver injury pattern (69.0%). International normalized ratio, hepatic encephalopathy grades, the use of vasopressor, N-acetylcysteine, or artificial liver support system were associated with TFS and incorporated to construct a nomogram model (drug-induced acute liver failure-5, DIALF-5). The AUROC of DIALF-5 for 7-day, 21-day, 60-day, and 90-day TFS in the internal cohort were 0.886, 0.915, 0.920, and 0.912, respectively. Moreover, the AUROC of DIALF-5 for 21-day TFS had the highest AUROC, which was significantly higher than 0.725 of MELD and 0.519 of KCC (p < 0.05), numerically higher than 0.905 of ALFSG-PI but without statistical difference (p > 0.05). These results were successfully validated in the external cohort (147 patients). Conclusions Based on easily identifiable clinical data, the novel DIALF-5 model was developed to predict transplant-free survival in non-APAP drug-induced ALF, which was superior to KCC, MELD and had a similar prediction performance to ALFSG-PI but is more convenient, which can directly calculate TFS at multiple time points.

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Severe perianal shingles during azathioprine and budesonide treatment for Crohn's disease—preventable with zoster vaccine?

Cited by 4 publications

References 11 publications

A Rare Case of Varicella Zoster Infection in Hemorrhoids in a Patient With Inflammatory Bowel Disease

A Rare Case of Varicella Zoster Infection in Hemorrhoids in a Patient With Inflammatory Bowel Disease

Hypertrophic Perianal Herpes Mimicking Squamous Cell Cancer: A Case Report and a Review of the Literature

Clinical characteristics and prognosis of non-APAP drug-induced acute liver failure: a large multicenter cohort study

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