Alsultan Mohammad, Kliea Marwa, Hassan Qussai, Basha Kassem
Department of Nephrology, Al Assad and Al Mouwasat University Hospitals, Damascus University Faculty of Medicine.
Department of Neurology, Al Assad and Al Mouwasat University Hospitals, Damascus University Faculty of Medicine.
Ann Med Surg (Lond). 2023 Mar 2;85(3):481-485. doi: 10.1097/MS9.0000000000000231. eCollection 2023 Mar.
Kidney transplant recipients are at increasing risk for reactivation of varicella-zoster virus (VZV) infection.
A 31-year-old male was admitted with fever, chest pain, and dyspnea. Also, the complaints accompanied by generalized maculopapular, vesicular, hemorrhagic, itching, and painful rash with pustules and crusts on an erythematous base fill the entire body for the last 10 days. Chest computed tomography scan showed diffuse miliary and ground-glass opacities. The patient had a previous history of chickenpox infection in childhood, no recent contact with individuals suffering from VZV infection, and no known pretransplant serology for VZV. Due to the high clinical suspicion of reactivated VZV with pneumonitis and severe disseminated form, we started the treatment with intravenous acyclovir (ACV) for 10 days followed by oral ACV for a total of 21 days, along with stopping mycophenolate mofetil and increasing the prednisolone dose to 10 mg/d. The clinical status was improved and the rash receded with a flaked surface for old lesions.
We experienced a successful ACV treatment for delayed and severe VZV infection with a literature review of VZV pneumonitis among kidney transplant recipients. To the best of our knowledge, this is the first case that presented a disseminated skin form with pneumonitis of VZV from Syria. This case supports the initiation of antiviral therapy for transplant patients even after 72 hours the onset of the rash despite the lack of evidence in these circumstances.
肾移植受者感染水痘 - 带状疱疹病毒（VZV）再激活的风险日益增加。
一名31岁男性因发热、胸痛和呼吸困难入院。此外，在过去10天里，全身出现伴有红斑基底上的全身性斑丘疹、水疱、出血性、瘙痒性、疼痛性皮疹，并伴有脓疱和结痂。胸部计算机断层扫描显示弥漫性粟粒状和磨玻璃样混浊。该患者童年时有水痘感染史，近期未接触过感染VZV的个体，移植前也没有已知的VZV血清学检查结果。由于高度怀疑VZV再激活伴肺炎及严重播散形式，我们开始静脉注射阿昔洛韦（ACV）治疗10天，随后口服ACV共21天，同时停用霉酚酸酯并将泼尼松龙剂量增加至10mg/d。临床状况改善，皮疹消退，旧病灶表面有鳞屑。
我们对肾移植受者中的VZV肺炎进行文献回顾，并成功地用ACV治疗了延迟和严重的VZV感染。据我们所知，这是叙利亚首例出现VZV肺炎伴播散性皮肤表现的病例。该病例支持即使在皮疹出现72小时后，对于移植患者也应启动抗病毒治疗，尽管在这些情况下缺乏证据。
