Infect Chemother.  2019 Sep;51(3):310-314. 10.3947/ic.2019.51.3.310.

Successful Treatment of Fulminant Hepatitis due to Varicella Zoster Virus using Immunoglobulin in a Kidney Transplant Patient

• Hsing LC
• Kim JY
• Kwon JS
• Shin EC
• Kim SH

• KMID: 2459047
• DOI: http://doi.org/10.3947/ic.2019.51.3.310

Abstract

The clinical benefit of adjuvant intravenous immunoglobulin (IVIG) therapy is controversial in immunocompromised patients with severe varicella. A twenty-one-year-old woman who had received a kidney transplant one year earlier presented with fever and generalized rash for 5 days. Initial immunoglobulin M (IgM) and IgG for varicella zoster virus (VZV) were negative; however, the patient was diagnosed with varicella with fulminant hepatitis because VZV-specific PCR from skin vesicles and blood was positive. The patient received intravenous acyclovir and 5-day IVIG. The decline of plasma viral load was steeper (beta coefficient −0.446) during IVIG therapy than after the therapy (beta coefficient −0.123) (P = 0.04), while VZV glycoprotein IgG titers and VZV-specific T cell responses were not detected during the 5-day IVIG therapy. The patient improved without any complications. This case provides an experimental evidence that adjuvant IVIG can significantly reduce viral load in immunocompromised patients with severe varicella.

Keyword

Varicella zoster virus; Fatal hepatitis; Intravenous immunoglobulin

MeSH Terms

Acyclovir
Chickenpox*
Exanthema
Female
Fever
Glycoproteins
Hepatitis*
Herpesvirus 3, Human*
Humans
Immunocompromised Host
Immunoglobulin G
Immunoglobulin M
Immunoglobulins*
Immunoglobulins, Intravenous
Kidney*
Plasma
Polymerase Chain Reaction
Skin
Viral Load
Acyclovir
Glycoproteins
Immunoglobulin G
Immunoglobulin M
Immunoglobulins
Immunoglobulins, Intravenous

Figure

• 

  Figure 1 (A) Detailed kinetic data on varicella-zoster virus (VZV) DNA loads in plasma and saliva, and alanine aminotransferase, according to days after symptom onset in a 21-year-old woman with fulminant varicella hepatitis. The decline in viral copies in plasma (pupple line) and saliva (orange line), and alanine aminotransferase (sky blue line) are shown. The duration of antimicrobial therapy and intravenous immunoglobulin(IVIG) is shown by the yellow bars. The dashed line represents the day of hospitalization. (B) Changes of VZV glycoprotein IgG titer and (C) VZV lysate-specific T cell response as a function of hospital day. (PBMCs: peripheral blood mononuclear cells).

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