Mamiya Takahiro, Kobayashi Hironori, Takeuchi Shunta, Tago Mayumi, Ikenouchi Tadasuke
Education and Training, Handa City Hospital, Handa, JPN.
Respiratory Medicine, Handa City Hospital, Handa, JPN.
Cureus. 2024 Nov 21;16(11):e74183. doi: 10.7759/cureus.74183. eCollection 2024 Nov.
The global prevalence of rheumatoid arthritis (RA) is increasing, resulting in an increased use of Janus kinase (JAK) inhibitors. Several cases of varicella-zoster virus (VZV) pneumonia in patients with RA have been reported. However, to our knowledge, no reports have demonstrated conclusive evidence of VZV reinfection in this patient population. This case report describes a 52-year-old female with RA who developed severe VZV pneumonia. The patient was treated with a combination of methotrexate, baricitinib, and iguratimod. She had a history of chickenpox during childhood and had not been vaccinated against VZV. Two weeks after her family member was infected by shingles, the patient developed multiple vesicles throughout her body. The patient was diagnosed with VZV reinfection based on the history and serological testing. She was admitted and treated with intravenous acyclovir for the disseminated VZV infection. Despite treatment, her condition rapidly deteriorated, progressing to acute respiratory distress syndrome. Chest computed tomography revealed diffuse bilateral ground-glass opacities, nodules, and consolidations, consistent with VZV pneumonia. The patient required high-flow nasal cannula oxygen and steroid therapy. Following the administration of acyclovir and steroids, the patient gradually improved and was discharged on the 15th day of admission. This case highlights the risk of severe VZV infection in patients with RA, particularly in those treated with JAK inhibitors. This underscores the importance of the VZV vaccination in this population. Despite the current guidelines recommending VZV vaccination, vaccination rates among immunosuppressed patients remain inadequate. Given the potential for VZV reinfection, vaccination is recommended, regardless of previous VZV infection status.
类风湿关节炎（RA）的全球患病率正在上升，导致Janus激酶（JAK）抑制剂的使用增加。已有数例RA患者发生水痘-带状疱疹病毒（VZV）肺炎的报道。然而，据我们所知，尚无报告证实该患者群体中存在VZV再次感染的确凿证据。本病例报告描述了一名52岁患RA的女性，她发生了严重的VZV肺炎。该患者接受了甲氨蝶呤、巴瑞替尼和艾拉莫德联合治疗。她童年时有水痘病史，未接种过VZV疫苗。在其家庭成员感染带状疱疹两周后，患者全身出现多处水疱。根据病史和血清学检测，该患者被诊断为VZV再次感染。她因播散性VZV感染入院并接受静脉注射阿昔洛韦治疗。尽管进行了治疗，但其病情迅速恶化，进展为急性呼吸窘迫综合征。胸部计算机断层扫描显示双侧弥漫性磨玻璃影、结节和实变，符合VZV肺炎表现。该患者需要高流量鼻导管给氧和类固醇治疗。在给予阿昔洛韦和类固醇后，患者逐渐好转，并于入院第15天出院。本病例突出了RA患者发生严重VZV感染的风险，尤其是那些接受JAK抑制剂治疗的患者。这强调了该人群接种VZV疫苗的重要性。尽管目前的指南推荐接种VZV疫苗，但免疫抑制患者的接种率仍然不足。鉴于存在VZV再次感染的可能性，无论之前的VZV感染状况如何，均建议接种疫苗。
