Kobayashi Hironori, Takeuchi Shunta, Torii Yuka, Ikenouchi Tadasuke, Kawada Jun-Ichi, Oka Keisuke, Kato Sayaka, Ogawa Masahiro
Department of Respiratory Medicine, Handa City Hospital, 2-29 Touyou-cho, Handa-shi, Aichi 475-8599, Japan.
Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
IDCases. 2023 Jul 29;33:e01866. doi: 10.1016/j.idcr.2023.e01866. eCollection 2023.
Varicella-zoster virus (VZV) infection in adults or immunocompromised patients has a more severe presentation compared to the mild disease in children. To the best of our knowledge, no reports have described the clinical course of VZV pneumonia focusing on time course of skin rash, chest computed tomography (CT) findings, and viral load. Furthermore, no reports have described the reactivation of human herpes virus 6 (HHV-6) in VZV pneumonia. Here, we report a case of severe VZV pneumonia that resulted in reactivation of HHV-6 in a patient with rheumatoid arthritis (RA). A 66-year-old female treated for RA was admitted to our hospital with papules. Her chest CT showed granular infiltrates, micronodules, and ground-glass opacities. The day after admission, because the typical skin rashes and chest CT findings were observed, she was diagnosed with VZV pneumonia and treated with acyclovir. Her skin rash then crusted over five days and entered the healing process, whereas it took approximately two weeks for her respiratory condition and chest CT findings to improve. In addition, VZV deoxyribonucleic acid (DNA) gradually decreased with treatment. On the 34th day of admission, VZV DNA was not found in the serum sample but remained in the sputum sample. Furthermore, although reactivation of HHV-6 was observed, viremia resolved without treatment. Clinicians should be able to recognize the differences in the improvement of skin rashes, respiratory status, and chest CT findings. In addition, treatment for HHV-6 reactivation should be carefully determined for each case.
与儿童的轻症水痘-带状疱疹病毒（VZV）感染相比，成人或免疫功能低下患者的VZV感染表现更为严重。据我们所知，尚无报告描述VZV肺炎的临床病程，重点关注皮疹的时间进程、胸部计算机断层扫描（CT）结果和病毒载量。此外，也没有报告描述VZV肺炎中人类疱疹病毒6型（HHV-6）的再激活情况。在此，我们报告一例严重VZV肺炎病例，该病例导致一名类风湿关节炎（RA）患者出现HHV-6再激活。一名因RA接受治疗的66岁女性因丘疹入住我院。她的胸部CT显示有颗粒状浸润、微小结节和磨玻璃样混浊。入院后第二天，由于观察到典型的皮疹和胸部CT表现，她被诊断为VZV肺炎并接受阿昔洛韦治疗。她的皮疹在五天后结痂并进入愈合过程，而她的呼吸状况和胸部CT表现改善则花费了大约两周时间。此外，随着治疗的进行，VZV脱氧核糖核酸（DNA）逐渐减少。入院第34天，血清样本中未检测到VZV DNA，但痰样本中仍有。此外，虽然观察到HHV-6再激活，但病毒血症未经治疗即消退。临床医生应能够认识到皮疹、呼吸状态和胸部CT表现改善方面的差异。此外，应针对每个病例仔细确定HHV-6再激活的治疗方法。
