acyclovir and Heart-Failure

A 97-year-old woman presented with 4-day history of vesicular rash, initially at the feet but then spread up to the thighs bilaterally, abdomen and trunk. The initial differentials included bullous pemphigus and cellulitis by the emergency department. She was then managed as bullous pemphigus by the acute medical team and started on high-dose steroids, with no other differentials considered. When her care was taken over by the general medical team, varicella zoster virus (VZV) infection was suspected. After confirmation by the dermatology team regarding the clinical diagnosis and the positive VZV DNA swabs, she was started on acyclovir.

Topics: Acyclovir; Administration, Intravenous; Aged, 80 and over; Antiviral Agents; Chickenpox; Diagnosis, Differential; Exanthema; Fatal Outcome; Female; Fever; Heart Failure; Herpesvirus 3, Human; Humans

A 97-year-old lady was hospitalized for left leg cellulitis. Comorbidity included hypertension and congestive heart failure. While in hospital, she developed a painless vesicular rash localized to the territory of the left trigeminal nerve (third branch), which evolved to pustules and crusts (Figure 1). A chickenpox-like disseminated eruption of vesicles followed within 4 days, with the same evolution pattern (Figure 2).The diagnosis of disseminated zoster was suspected. A PCR analysis confirmed the presence of varicella-zoster-virus (VZV) in an abdominal vesicle. The patient was treated with oral valacyclovir for 7 days. Clinical examination, laboratory tests (including HIV serology), and a chest radiograph revealed no evidence of underlying immunodeficiency or malignancy.

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Back; Face; Female; Heart Failure; Herpes Zoster; Herpesvirus 3, Human; Humans; Hypertension; Polymerase Chain Reaction; Valacyclovir; Valine

Topics: Acyclovir; Anemia, Hemolytic, Autoimmune; Anti-Inflammatory Agents; Antiviral Agents; Chickenpox; Heart Failure; Hepatitis, Viral, Human; Hepatomegaly; Herpesvirus 3, Human; Humans; Immunoglobulins, Intravenous; Immunologic Factors; Infant; Male; Methylprednisolone; Prednisolone; Splenomegaly

This study reports the development of lymphocytic myocarditis in a bilateral lung allograft recipient. A 23-year-old woman developed congestive heart failure and severe left ventricular dysfunction 32 months after a bilateral lung allograft for cystic fibrosis. She had taken oral acyclovir for infectious mononucleosis that was diagnosed 11 months previously. Her viral load for Epstein-Barr virus (EBV) increased, and an echocardiogram revealed a left ventricular ejection fraction of 25% and endomyocardial biopsy revealed lymphocytic myocarditis. She received valacyclovir (1 g x 3 times daily) and made a full recovery 6 months later.

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy, Needle; Cystic Fibrosis; Female; Follow-Up Studies; Heart Failure; Humans; Immunohistochemistry; Infectious Mononucleosis; Lung Transplantation; Lymphocytes; Myocarditis; Risk Assessment; Severity of Illness Index; Treatment Outcome; Valacyclovir; Valine