acyclovir and Dyspnea

Topics: Acyclovir; Diagnosis, Differential; Dyspnea; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunosuppressive Agents; Laryngitis; Laryngostenosis; Larynx; Male; Middle Aged; Multiple Myeloma; Tracheotomy; Treatment Outcome; Valacyclovir

Topics: Acyclovir; Antiviral Agents; Dyspnea; Enzyme Inhibitors; Hemolysis; Humans; Jaundice; Male; Methylene Blue; Middle Aged; Oxidative Stress; Renal Insufficiency; Treatment Outcome

Granulomatosis polyangiitis (GPA) is an ANCA-related vasculitis (AAV) whose clinical manifestations mainly concern the respiratory tract (upper and lower) and the kidney. The treatment of GPA (as well as other AAV) includes the use of immunosuppressive drugs with numerous side effects; the most frequent complications are infectious and neoplastic. GPA frequently relapses. Epstein Barr Virus (EBV) is a ubiquitous virus; it is estimated that about 90% of the world’s population has BEEN EXPOSED TO with this pathogen and has subsequently developed a latent infection. Under certain conditions including immunosuppression EBV may reactivate. We report the clinical case of a 67-year-old woman who presented with GPA involving the upper respiratory tract and renal failure with the need for hemodialysis treatment. The fourth month of induction therapy with cyclophosphamide and methylprednisone she presented with dyspnea and respiratory failure. After excluding pulmonary embolism and heart failure, a series of investigations including high resolution tomography and fibroscopy with broncoalveolar lavage (BAL) were performed which excluded recurrence of pulmonary vasculitis including alveolar haemorrhage A BAL demonstrated EBV-DNA. On this basis EBV pneumonia was diagnosed, and antiviral therapy with acyclovir was begun, followed by clinical and radiological improvement. In patients with GPA treated with immunosuppressive drugs pulmonary involvement may not only be due to the underlying vasculitis, but also to opportunistic agents, which must always be considered.

Topics: Acyclovir; Aged; Antiviral Agents; Cyclophosphamide; Disease Susceptibility; Dyspnea; Epstein-Barr Virus Infections; Female; Granulomatosis with Polyangiitis; Herpesvirus 4, Human; Humans; Immunocompromised Host; Immunosuppressive Agents; Kidney Failure, Chronic; Pneumonia, Viral; Prednisone; Renal Dialysis; Respiratory Insufficiency

We present a 36-year-old woman who was born and raised in Hongkong but currently lived in the Netherlands. She was admitted with a varicella-zoster virus (VZV) primo-infection complicated by pneumonia and hepatitis. The patient was successfully treated with aciclovir. Adult VZV primo-infections are uncommon in Dutch natives but occur more often in immigrants from countries with a temperate climate where less people are infected during childhood.

Topics: Acyclovir; Adult; Chickenpox; Dyspnea; Exanthema; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Netherlands; Treatment Outcome; Varicella Zoster Virus Infection

Topics: Acyclovir; Diagnosis, Differential; Dyspnea; Electrocardiography; Encephalitis, Varicella Zoster; Female; Humans; Immunosuppressive Agents; Infusions, Intravenous; Lethargy; Lupus Erythematosus, Systemic; Middle Aged; Pleural Effusion; Prednisone; Pulmonary Disease, Chronic Obstructive; Tachycardia

Topics: Acyclovir; Adult; Antiviral Agents; Bangladesh; Chickenpox; Diagnosis, Differential; Disease Transmission, Infectious; Dyspnea; Exanthema; Humans; Lung; Male; Pneumonia, Viral; Pruritus; Radiography