肾移植受者接种疫苗后播散性水痘感染。

Disseminated vaccine-induced varicella infection in a kidney transplant recipient.

机构信息

Department of Internal Medicine, University of Texas Medical Branch, Galveston, Texas, USA; Sealy Institute of Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA.

Sealy Institute of Vaccine Sciences, University of Texas Medical Branch, Galveston, Texas, USA; Department of Pediatrics, University of Texas Medical Branch, Galveston, Texas, USA.

出版信息

Am J Transplant. 2023 Nov;23(11):1806-1810. doi: 10.1016/j.ajt.2023.05.034. Epub 2023 Jun 5.

DOI:10.1016/j.ajt.2023.05.034

PMID:37286085

Abstract

A 33-year-old kidney transplant (KT) recipient presented with a disseminated pruritic, painful, vesicular rash and hepatitis 3 weeks after receiving a varicella vaccine (VAR). A skin lesion biopsy sent to the Centers for Disease Control and Prevention for genotyping confirmed vaccine-strain varicella-zoster virus (VZV) (Oka strain; vOka). The patient was successfully treated with intravenous acyclovir during a prolonged hospital stay. This case supports the contraindication of VAR in adult KT recipients and highlights the potential for severe illness when used in this population. Optimally, VZV-seronegative KT candidates should receive VAR before starting immunosuppressive medications. If this opportunity is missed, the recombinant varicella-zoster vaccine might be considered following transplantation as it is already recommended to prevent herpes zoster in VZV-seropositive immunocompromised adults. Further study is needed as data are limited on the safety and efficacy of recombinant varicella-zoster vaccine for primary varicella prevention in VZV-seronegative immunocompromised adults.

摘要

一名 33 岁的肾移植（KT）受者在接种水痘疫苗（VAR）后 3 周出现全身性瘙痒、疼痛、水疱性皮疹和肝炎。送往疾病控制与预防中心进行基因分型的皮肤病变活检证实为疫苗株水痘带状疱疹病毒（VZV）（Oka 株；vOka）。患者在长时间住院期间成功接受了静脉用阿昔洛韦治疗。该病例支持 VAR 在成人 KT 受者中的禁忌证，并强调了在该人群中使用时可能出现严重疾病。在开始免疫抑制药物治疗之前，VZV 血清阴性的 KT 候选者应接种 VAR。如果错过了这个机会，可以考虑在移植后使用重组水痘带状疱疹疫苗，因为已经建议使用该疫苗来预防 VZV 血清阳性免疫功能低下成年人的带状疱疹。由于有关 VZV 血清阴性免疫功能低下成年人中重组水痘带状疱疹疫苗用于原发性水痘预防的安全性和有效性的数据有限，因此需要进一步研究。