acyclovir and Hemorrhage

Interstitial nephritis due to viruses is well-described after solid organ transplantation. Viruses implicated include cytomegalovirus; BK polyomavirus; Epstein-Barr virus; and, less commonly, adenovirus. We describe a rare case of hemorrhagic allograft nephritis due to herpes simplex virus type 1 at 10 days after living donor kidney transplantation. The patient had a favorable outcome with intravenous acyclovir and reduction of immunosuppression.

Topics: Acyclovir; Allografts; Antiviral Agents; Glomerular Filtration Rate; Graft Rejection; Graft Survival; Hemorrhage; Herpes Simplex; Herpesvirus 1, Human; Humans; Immunosuppression Therapy; Kidney Failure, Chronic; Kidney Function Tests; Kidney Transplantation; Male; Middle Aged; Nephritis; Prognosis; Risk Factors

Topics: Acyclovir; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Blister; Hemorrhage; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunologic Factors; Male; Opportunistic Infections; Purpura, Thrombocytopenic, Idiopathic; Rituximab; Valacyclovir; Valine

Topics: Acyclovir; Antiviral Agents; Glucocorticoids; Hemorrhage; Herpes Zoster; Humans; Immunoglobulins, Intravenous; Male; Middle Aged; Prednisone; Purpura, Thrombocytopenic, Idiopathic; Skin Diseases, Vesiculobullous; Splenectomy; Valacyclovir; Valine

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

Topics: Acyclovir; Aged; Antiviral Agents; Graft Rejection; Hemorrhage; Herpes Zoster; Humans; Kidney Transplantation; Male; Treatment Outcome

A 43-year-old Japanese woman underwent unrelated cord blood transplantation (CBT) during remission for acute lymphoblastic leukemia with t(4; 11)(q21;q23). Tacrolimus was given for prophylaxis of graft-versus-host disease. The posttransplantation clinical course was mostly uneventful, and the leukemia remained in remission. Fourteen months after CBT, the patient developed pancytopenia and hepatic dysfunction with persistent high-grade fever. The bone marrow was hypocellular with increased numbers of macrophages and hemophagocytes. The numbers of Epstein-Barr virus (EBV) copies in peripheral blood samples were remarkably high. Although the patient showed complete donor-type hematopoiesis, the titer of viral capsid antigen immunoglobulin G was low, and the results of a test for EBV nuclear antigen were negative. There was no clinical response to the reduction of immunosuppressive therapy or to the administration of high-dose methylprednisolone, human immunoglobulin, or acyclovir. The patient died 466 days after CBT of massive gastrointestinal hemorrhage due to bone marrow and hepatic failures. This case demonstrates that fatal EBV-associated hemophagocytic syndrome (HPS) can occur more than 1 year after CBT. This report is the first of a case of late-onset EBV-associated HPS following CBT.

Topics: Acyclovir; Adult; Anti-Inflammatory Agents; Antibodies, Viral; Antiviral Agents; Bone Marrow Diseases; Epstein-Barr Virus Infections; Epstein-Barr Virus Nuclear Antigens; Female; Hematopoiesis; Hemorrhage; Herpesvirus 4, Human; Humans; Immunoglobulin G; Liver Failure; Lymphohistiocytosis, Hemophagocytic; Methylprednisolone; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Time Factors; Transplantation Chimera

When adenovirus causes haemorrhagic cystitis in immunocompromised patients, vidarabine is used for its treatment because therapeutic choice is limited. Although vidarabine has been reported to be effective for these patients, its therapeutic basis has not yet been established. Vidarabine dose-dependently inhibited viral replication as assessed by a yield reduction assay. Viral protein synthesis was dose-dependently inhibited by vidarabine but not at all by acyclovir, and the degree of inhibition by vidarabine was different for each of the viral proteins, ranging from 0-40% of the untreated control. These results indicated the specificity and mechanism of action of vidarabine against adenovirus. The concentration of vidarabine and its metabolite in the bladder is suggested to exhibit effective anti-adenoviral activity in suppressing the replication of adenovirus. Thus, our results support vidarabine therapy as a possible candidate for adenovirus-induced haemorrhagic cystitis in immunocompromised patients.

Topics: Acyclovir; Adenoviridae; Adenoviridae Infections; Antiviral Agents; Cystitis; Dose-Response Relationship, Drug; Hemorrhage; Humans; Immunocompromised Host; Urinary Bladder; Vidarabine; Viral Proteins

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Female; Hemorrhage; Humans; Infusions, Intravenous; Leukemia

We treated two patients with herpes zoster ophthalmicus in whom hyphema and hemorrhagic glaucoma occurred. Case 1 complained of facial skin eruption, and was given intravenous acyclovir for 7 days. Hyphema and high intraocular pressure occurred in the left eye 10 days after the onset of the skin eruption. Case 2 had severe pain and blisters on her face, and was given intravenous acyclovir for 7 days. An intracameral hemorrhage and glaucoma developed in the right eye 15 days after the onset of the skin lesion. Intravenous acyclovir may be necessary for longer than 7-day periods if the iridocyclitis remains.

Topics: Acyclovir; Aged; Aged, 80 and over; Dermatitis; Eye Diseases; Face; Glaucoma; Hemorrhage; Herpes Zoster Ophthalmicus; Humans; Hyphema; Injections, Intravenous; Male