Silk H J, Guay-Woodford L, Perez-Atayde A R, Geha R S, Broff M D
Division of Allergy, Children's Hospital, Boston, Mass.
J Allergy Clin Immunol. 1988 Jan;81(1):47-51. doi: 10.1016/0091-6749(88)90219-9.
Disseminated varicella infection is a potentially life-threatening complication of chronic high-dose corticosteroid (CS) or immunosuppressive therapy. A review of the literature indicates that, with one possible exception, this complication has not occurred in a CS-dependent subject with asthma. We present in this article the clinical features and autopsy findings of a steroid-dependent subject with asthma who died of acute, disseminated varicella. A 16-year-old poorly compliant, steroid-dependent subject with asthma received two courses of high-dose intravenous methylprednisolone during a 3-week period, followed by a tapering schedule of oral prednisone. During this time, she was exposed to chickenpox. She subsequently developed a classic varicella rash, sever back pain, rapidly progressive hepatic failure, pneumonitis, and encephalopathy. Death ensued 3 days after the onset of the rash. Evidence of disseminated varicella infection was confirmed at autopsy. This case illustrates that a small number of subjects with severe asthma receiving high-dose CS need to be considered as a separate, high-risk group for developing disseminated varicella. We recommend that the immune status of these patients to varicella-zoster virus be assessed by a serum titer. If these patients are nonimmune, they would be candidates for varicella-zoster immune globulin on exposure, and for acyclovir therapy should varicella dissemination occur.
播散性水痘感染是慢性高剂量皮质类固醇（CS）或免疫抑制治疗可能危及生命的并发症。文献综述表明，除了一个可能的例外，这种并发症尚未在依赖CS的哮喘患者中出现。我们在本文中呈现了一名依赖类固醇的哮喘患者死于急性播散性水痘的临床特征和尸检结果。一名16岁依从性差、依赖类固醇的哮喘患者在3周内接受了两个疗程的高剂量静脉注射甲泼尼龙，随后逐渐减量口服泼尼松。在此期间，她接触了水痘。她随后出现了典型的水痘皮疹、严重背痛、快速进展的肝功能衰竭、肺炎和脑病。皮疹出现3天后死亡。尸检证实存在播散性水痘感染。该病例表明，少数接受高剂量CS的重度哮喘患者需要被视为发生播散性水痘的一个单独的高危群体。我们建议通过血清滴度评估这些患者对水痘-带状疱疹病毒的免疫状态。如果这些患者无免疫力，接触水痘后他们将成为水痘-带状疱疹免疫球蛋白的适用对象，水痘播散发生时则适用阿昔洛韦治疗。
