Sato A, Amada N, Kikuchi H, Fukumori T, Haga I, Takahashi Y
Department of Surgery, Sendai Shakaihoken Hospital, Sendai, Japan.
Transplant Proc. 2009 Nov;41(9):3959-61. doi: 10.1016/j.transproceed.2009.06.195.
Varicella pneumonia is one of the serious complications of primary varicella zoster virus (VZV) infection in adults. A 36-year-old woman with end-stage renal disease underwent renal transplantation from a living donor in 1998, receiving immunosuppressive treatment with cyclosporine, mycophenolate mofetil, and methylprednisolone. She had a history of VZV infection during childhood. The patient developed an intractable cough on December 10, 2006, but there were no abnormalities in the laboratory data or chest radiograph for several weeks. On January 1, 2007, she was admitted to our hospital with cutaneous vesicles covering the entire body. We learnt that when her symptoms developed, her son was diagnosed with varicella. The chest radiograph at this stage showed a diffuse miliary pattern in the entire lung field. We started intravenous administration of acyclovir. VZV antigen was detected in the cutaneous lesions and VZV antibody in the serum after the start of these treatments, so we continued to administer acyclovir for 18 days. The cutaneous lesions healed and the pneumonia improved based on the chest radiograph. She was discharged from the hospital on January 19, 2007. In conclusion, this report documents VZV reinfection in a transplant patient.
水痘肺炎是成人原发性水痘带状疱疹病毒（VZV）感染的严重并发症之一。一名36岁的终末期肾病女性于1998年接受了活体供者的肾移植，接受环孢素、霉酚酸酯和甲泼尼龙的免疫抑制治疗。她童年时有VZV感染史。2006年12月10日，患者出现顽固性咳嗽，但数周内实验室检查数据和胸部X线片均无异常。2007年1月1日，她因全身出现皮肤水疱入住我院。我们了解到，在她出现症状时，她的儿子被诊断为水痘。此时的胸部X线片显示全肺野呈弥漫性粟粒样改变。我们开始静脉注射阿昔洛韦。在开始这些治疗后，在皮肤病变中检测到VZV抗原，在血清中检测到VZV抗体，因此我们继续给予阿昔洛韦治疗18天。皮肤病变愈合，根据胸部X线片显示肺炎有所改善。她于2007年1月19日出院。总之，本报告记录了一名移植患者的VZV再感染情况。
