acyclovir and Abdominal-Pain

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Diagnosis, Differential; Fatal Outcome; Hepatitis; Herpesvirus 3, Human; Humans; Liver; Liver Failure, Acute; Male

A young, previously healthy woman developed bilateral exudative tonsillitis that was associated with severe systemic symptoms. This was followed by evidence of multisystem disease with acute abdominal pain, raised liver enzyme levels, respiratory difficulty, increasing drowsiness and multiple vesicular skin lesions. Herpes simplex virus type-1 was isolated from skin lesions and a throat swab and herpes simplex virus type-1 antigen was detected in a liver biopsy sample. She recovered rapidly without any sequelae after treatment with intravenously administered acyclovir.

Topics: Abdominal Pain; Acyclovir; Adult; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immune Tolerance

The objectives of this study were (i) to describe the clinical presentation, treatment and outcome of paediatric inflammatory multisystem syndrome temporally related to Sars-CoV-2 (PIMS-TS) in children; (ii) to propose a framework to guide multidisciplinary team (MDT) management; and (iii) to highlight the role of the paediatric rheumatologist in this context.. This study involved a retrospective case notes review of patients referred to a single specialist paediatric centre with suspected PIMS-TS, with a focus on clinical presentation, laboratory parameters, treatment, and outcome in the context of an MDT framework.. Nineteen children of median age 9.1 years fulfilled the definition of PIMS-TS and were managed within an MDT framework: 5/19 were female; 14/19 were of Black, Asian or minority ethnicity; 9/19 also fulfilled diagnostic criteria for complete or incomplete Kawasaki disease (KD). Severe systemic inflammation, shock, and abdominal pain were ubiquitous. Treatment was stratified within an MDT framework and included CSs in all; i.v. immunoglobulin in all; anakinra in 4/19; infliximab in 1/19; and antiviral (aciclovir) in 4/19.. We observed significant diagnostic equipoise using a current definition of PIMS-TS, overlapping with KD. Outside of clinical trials, an MDT approach is vital. The role of the paediatric rheumatologist is to consider differential diagnoses of hyperinflammation in the young, to advise on empiric immunomodulatory therapy, to set realistic therapeutic targets, to gauge therapeutic success, to oversee timely step-down of immunomodulation, and to contribute to the longer-term MDT follow-up of any late inflammatory sequelae.

Topics: Abdominal Pain; Acyclovir; Adolescent; Adrenal Cortex Hormones; Antirheumatic Agents; Antiviral Agents; Asian People; Black People; Child; COVID-19; COVID-19 Drug Treatment; Diagnosis, Differential; Female; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Inflammation; Infliximab; Interleukin 1 Receptor Antagonist Protein; Male; Mucocutaneous Lymph Node Syndrome; Patient Care Team; Physician's Role; Retrospective Studies; Rheumatologists; SARS-CoV-2; Severity of Illness Index; Shock; Systemic Inflammatory Response Syndrome; United Kingdom; White People

Topics: Abdominal Pain; Acyclovir; Administration, Intravenous; Adult; Anti-HIV Agents; Antiretroviral Therapy, Highly Active; Exanthema; Female; Fever; Herpesvirus 3, Human; HIV Infections; Humans; Immunocompromised Host; Liver; Treatment Outcome; Varicella Zoster Virus Infection

Visceral disseminated varicella zoster virus (VDVZV) infection is a rare disease with a high mortality rate (55%) in immunocompromised patients, but it is not yet widely recognized in the field of nephrology. We report a case of VDVZV contracted during immunosuppressive therapy for membranous nephropathy.. A 36-year-old woman was diagnosed with membranous nephropathy and was being treated with immunosuppressive therapy consisting of 60 mg/day prednisolone, 150 mg/day mizoribine, and 150 mg/day cyclosporine. Nephrosis eased; therefore, the prednisolone dosage was reduced. However, 50 days after starting immunosuppressive therapy, the patient suddenly developed strong and spontaneous abdominal pain, predominantly in the epigastric area, without muscular guarding or rebound tenderness. Blood data indicated neutrophil-dominant elevated white blood cell count, reduced platelet count, elevated transaminase and lactate dehydrogenase, slightly increased C-reactive protein, and enhanced coagulability. Abdominal computed tomography revealed a mildly increased enhancement around the root of the superior mesenteric artery with no perforation, intestinal obstruction, or thrombosis. The cause of the abdominal pain was unknown, so the patient was carefully monitored and antibiotic agents and opioid analgesics administered. The following day, blisters appeared on the patient's skin, which were diagnosed as varicella. There was a marked increase in the blood concentration of VZV-DNA; therefore, the cause of the abdominal pain was diagnosed as VDVZV. Treatment with acyclovir and immunoglobulin was immediately started, and the immunosuppressive therapy dose reduced. The abdominal pain resolved rapidly, and the patient was discharged 1 week after symptom onset.. This patient was VZV-IgG positive, but developed VDVZV due to reinfection. Abdominal pain due to VDVZV precedes the skin rash, which makes it difficult to diagnose before the appearance of the rash, but measuring the VZV-DNA concentration in the blood may be effective. Saving the patient's life requires urgent administration of sufficient doses of acyclovir and reduced immunosuppressive therapy.

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Blood Cell Count; DNA, Viral; Female; Glomerulonephritis, Membranous; Herpesvirus 3, Human; Humans; Immunoglobulins; Immunosuppressive Agents; Tomography, X-Ray Computed; Varicella Zoster Virus Infection

Topics: Abdominal Pain; Acyclovir; Adolescent; Antiviral Agents; Diagnosis, Differential; Endoscopy, Gastrointestinal; Esophagitis; Esophagus; Herpes Simplex; Humans; Male; Simplexvirus

Gastric involvement with the varicella-zoster virus is an uncommon clinical condition where early suspicion and diagnosis are important to prevent the consequences deriving from its high morbidity and mortality, which in immunocompromised patients oscillate between 9% and 41% according to the various series. Two cases of gastric involvement with the varicella-zoster virus (VZV) in two patients with blood cancer are reported below. Gastric lesions are usually preceded by typical papulovesicular skin lesions. When gastric involvement is the first symptom of the disease its diagnosis and management may be delayed, which may entail severe consequences for immunocompromised patients. It is therefore that we suggest its inclusion in the algorithm for immunocompromised patients with abdominal pain and ulcer-like endoscopic lesions.

Topics: Abdominal Pain; Acyclovir; Antiviral Agents; Chickenpox; Female; Hematologic Neoplasms; Humans; Immunocompromised Host; Middle Aged; Stomach Diseases

Topics: Abdominal Pain; Acyclovir; Aged; Biopsy, Needle; Colitis, Ulcerative; Female; Follow-Up Studies; Gastric Mucosa; Gastroscopy; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunohistochemistry; Infusions, Intravenous; Rare Diseases; Severity of Illness Index; Treatment Outcome; Viremia

Varicella zoster virus (VZV) disease is one of the major infectious complications that can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Many reports have shown visceral VZV infection, a special type of VZV disease, to be rare. However, few studies so far have included a large number of patients.. Visceral VZV infection was found in 20 (0.8%) of 2411 patients who underwent allo-HSCT at our hospitals. Seventeen (85%) patients were taking immunosuppressive agents at the time of presentation with zoster. The presenting symptom was abdominal pain in 16 patients (80%), unconsciousness in 3 patients (15%), and no symptoms in 1 patient. The mean time interval from allo-HSCT to symptomatic visceral VZV infection was 273 days (103-800 days). The eruptions appeared within 3 days (0-13) after the first symptoms. Treatment with intravenous acyclovir was initiated before the appearance of eruptions in 3 of 18 patients (all 3 survived) with vesicular eruptions, the same day in 12 patients (11 survived, 1 died), and after the appearance in 3 patients (1 survived, 2 died). The overall mortality was 20%.. In conclusion, these data confirm that the incidence of visceral VZV infection is infrequent, but this disease is serious. When patients being treated with immunosuppressive agents demonstrate abdominal pain or unconsciousness, the possibility of visceral VZV infection should be considered as well as earlier therapeutic intervention.

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Chronic Disease; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Incidence; Male; Middle Aged; Transplantation, Homologous; Unconsciousness; Virus Activation; Viscera; Young Adult

Topics: Abdominal Pain; Acyclovir; Aged; Antiviral Agents; Exanthema; Hepatitis; Herpes Genitalis; Herpesvirus 2, Human; Humans; Male; Pancreatitis; Skin Diseases, Vesiculobullous; Treatment Outcome

The varicella zoster virus (VZV) is a very rare cause of gastritis. Gastritis caused by VZV can be presented as abdominal pain, vomiting. Most of the cases reported with varicella gastritis in the literature are immunocompromised patients with various kinds of malignancy, and most of these patients are adults. Here we report an adolescent girl with acute abdominal pain. The girl was immunocompetent. Her endoscopically taken biopsy material revealed varicella, and her gastritis was healed with acyclovir therapy. This is a very rare condition and not frequently reported in the literature. The authors want to drive attention to the fact that varicella gastritis can be seen in immunocompetent children, the presentation can be nausea, vomiting and/or (severe) abdominal pain. Serological studies may be less helpful than tissue studies, so interventional procedures should be done.

Topics: Abdominal Pain; Acyclovir; Adolescent; Antiviral Agents; Biopsy; Chickenpox; Female; Gastritis; Gastroscopy; Herpesvirus 3, Human; Humans; Treatment Outcome

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Azathioprine; Connective Tissue Diseases; Female; Herpes Zoster; Humans; Immunocompromised Host; Immunosuppressive Agents; Prednisolone; Treatment Outcome

We report a patient presenting with severe epigastric pain and diffuse abdominal tenderness, with negative imaging and endoscopic evaluation. During hospitalization, the patient developed confusion, seizures, pneumonia, anemia and thrombocytopenia. A hemorrhagic rash appeared on day nine of admission, with serology and skin biopsy confirming a diagnosis of hemorrhagic varicella.

Topics: Abdominal Pain; Acyclovir; Antiviral Agents; Chickenpox; Confusion; Exanthema; Female; Hemorrhage; Humans; Leukemia, Myeloid, Acute; Middle Aged

A 42-year-old woman was referred with fever and abdominal pain with peritoneal irritation. A diagnostic laparoscopy showed hepatic lesions. Histopathological investigation of the liver biopsy showed hepatitis caused by herpes simplex virus (HSV). The patient was treated with acyclovir and recovered well. HSV is a rare cause of viral hepatitis and has a high mortality rate.

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; Female; Hepatitis, Viral, Human; Herpes Simplex; Humans; Immunocompetence; Treatment Outcome

Acute disseminated encephalomyelitis is an uncommon inflammatory demyelinating disease of the central nervous system. It generally presents after a nonspecific viral infection. We describe a case of a male adolescent who presented to the emergency department with vomiting and lethargy. A review of the pathophysiology and clinical presentation for acute disseminated encephalomyelitis is presented here.

Topics: Abdominal Pain; Acyclovir; Adrenal Cortex Hormones; Child; Demyelinating Autoimmune Diseases, CNS; Encephalomyelitis, Acute Disseminated; Gait Ataxia; Humans; Magnetic Resonance Imaging; Male; Mood Disorders; Prognosis; Respiratory Tract Infections; Vomiting

A hematopoietic stem cell transplant recipient developed abdominal pain, pneumatosis intestinalis, hepatitis, pancreatitis, and inappropriate antidiuretic hormone secretion. Blood for varicella-zoster virus (VZV) DNA polymerase chain reaction was positive. She was treated with acyclovir and subsequently developed VZV antigen-positive zoster. Detection of VZV DNA in blood may be useful for early diagnosis in immunocompromised hosts who present with zoster without skin lesions.

Topics: Abdominal Pain; Acyclovir; Adult; Antiviral Agents; DNA, Viral; Female; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Pancreatitis; Pneumatosis Cystoides Intestinalis; Polymerase Chain Reaction; Vasopressins

We report an immunocompetent woman with multisystem organ failure following herpes simplex virus type 2 (HSV-2) hepatitis. After she initially responded to intravenous acyclovir, she was switched to oral valacyclovir. She developed respiratory failure and opportunistic infections and died. Autopsy confirmed disseminated HSV infection, and lung tissue grew acyclovir-resistant HSV-2.

Topics: Abdominal Pain; Acyclovir; Adult; Drug Resistance, Viral; Female; Hepatitis, Viral, Human; Herpes Simplex; Herpesvirus 2, Human; Humans; Immunocompetence; Treatment Failure

The current communication describes clinical findings in two recipients of allogeneic bone marrow transplantation (BMT) with varicella zoster virus infection who complained of acute severe abdominal pain preceding cutaneous manifestations. Physical examination, laboratory data and gastroscopic findings were nonspecific. In these cases, acyclovir was very effective for the symptoms. Varicella zoster virus infection should be suspected in BMT recipients who have rebellant acute abdominal pain but no characteristic skin eruptions.

Topics: Abdominal Pain; Acute Disease; Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Herpes Zoster; Herpesvirus 3, Human; Humans; Male; Skin Diseases, Infectious; Transplantation, Homologous

A 26-year old man was admitted because of acute abdominal pain. He had received an allogeneic bone marrow transplant (BMT) for aplastic anemia 6 months before. All physical, laboratory, roentgenographic, and ultrasonographic studies were performed but nondiagnostic. On the fourth hospital day the patient developed visual disturbance and on the following day skin eruption appeared. Laboratory findings revealed severe liver dysfunction. We diagnosed this case as varicella-zoster virus (VZV) infection with visceral dissemination. Antiviral therapy with acyclovir was initiated and abdominal pain markedly reduced and visual acuity was recovered after 4 days. In case of VZV infection, acute abdominal pain prior to skin eruptions is rare. However in such cases the patients are highly fatal due to visceral dissemination. Antiviral therapy begun before visceral dissemination of VZV is highly effective in preventing serious disease, whereas it is less effective after dissemination. We consider that early diagnosis and treatment of VZV infection is necessary for BMT recipients who are undergoing immunosuppressive therapy.

Topics: Abdominal Pain; Acute Disease; Acyclovir; Adult; Anemia, Aplastic; Antiviral Agents; Bone Marrow Transplantation; Herpes Zoster; Humans; Immunocompromised Host; Male; Opportunistic Infections; Transplantation, Homologous

Abdominal and back pain has until now been reported as a first sign of severe varicella in immunocompromised children only. We report two adult leukemia patients in whom these symptoms preceded visceral dissemination of varicella infection. Recognizing that this syndrome may occur in adult patients is of clinical importance, since it allows early diagnosis and treatment of the infection.

Topics: Abdominal Pain; Acyclovir; Adult; Back Pain; Chickenpox; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Male; Middle Aged; Precursor Cell Lymphoblastic Leukemia-Lymphoma