acyclovir and Lupus-Erythematosus--Systemic

Koebner phenomenon is defined as a nonspecific skin stimulus eliciting a disease skin reaction. The nature of the skin trauma varies greatly and includes areas of thermal injury, excoriations, surgical incisions, and scars. We report a patient with recent onset of systemic lupus erythematosus who developed Herpes zoster on immunosuppressant medication. Two weeks after resolution of the vesicles, the patient presented with new ulcerative reddish lesions over the herpes zoster scare and worsening of her malar rash without evidence of worsening of any other organ. Koebner phenomenon was suspected. We review the literature on Koebner phenomenon in SLE.

Topics: Acyclovir; Adolescent; Antiviral Agents; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Lupus Erythematosus, Discoid; Lupus Erythematosus, Systemic; Skin

Herpes simplex virus (HSV) hepatitis is a rare complication of HSV infection with a high reported mortality rate in untreated patients. The authors present a case of HSV hepatitis in a 26-year-old female with focal proliferative lupus nephropathy who was status post one cycle of pulse high-dose (1 gm/ m2) cyclophosphamide. Treatment with parenteral acyclovir was successful. A meta analysis of well-documented cases of HSV hepatitis treated with acyclovir, excluding those that omit initial serum concentrations of hepatic transaminases, suggests that the early administration of parenteral acyclovir may have been instrumental in the achievement of a successful outcome, and that a patient's serum levels of hepatic transaminases at the time of treatment initiation may predict outcome. This is the first reported case of successful parenteral acyclovir treatment of HSV hepatitis in a patient with lupus nephritis who has recently undergone cyclophosphamide immunosuppression, and includes a meta analysis to examine the hypothesis that initial markers of hepatic injury may predict outcome of acyclovir treatment.

Topics: Acyclovir; Adult; Antiviral Agents; Female; Hepatitis; Herpesvirus 2, Human; Humans; Liver Function Tests; Lupus Erythematosus, Systemic; Treatment Outcome

Visceral disseminated varicella zoster virus (VZV) infection is a rare but life-threatening complication in immunosuppressed patients. Herein, we report a survival case of visceral disseminated VZV infection in a patient with systemic lupus erythematosus (SLE).. A 37-year-old woman was diagnosed as SLE and initial induction therapy was started. Two months after starting the immunosuppressive therapy consisting of 40 mg of prednisolone (PSL) and 1500 mg of mycophenolate mofetil (MMF) daily, she suddenly developed strong abdominal pain, which was required opioid analgesics, followed by systemic skin blisters, which were diagnosed as varicella. Laboratory findings showed rapid exacerbation of severe liver failure, coagulation abnormalities and increased numbers of blood VZV deoxyribonucleic acid (DNA). Therefore, she was diagnosed as visceral disseminated VZV infection. Multidisciplinary treatment with acyclovir, immunoglobulin and antibiotics was started, the dose of PSL was reduced, and MMF was withdrawn. By their treatment, her symptoms were resolved and she finally discharged.. Our case highlights the importance of a clinical suspicion of visceral disseminated VZV infections, and the necessity of immediate administration of acyclovir and reduced doses of immunosuppressant to save patients with SLE.

Topics: Acyclovir; Adult; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lupus Erythematosus, Systemic; Mycophenolic Acid; Prednisolone; Varicella Zoster Virus Infection

BACKGROUND Varicella zoster virus (VZV) infection can increase the risk of cerebrovascular disease, involving small and large arteries, especially in immunosuppressed patients with ophthalmic division of the trigeminal nerve involvement. We present the case of a patient with intracerebral VZV vasculopathy without overt clinical manifestation but with abnormal imaging findings in the brain magnetic resonance (MR). CASE REPORT A 59-year-old woman with systemic lupus erythematosus (SLE), without other traditional cardiovascular risk factors, presented to the hospital due to headache, vertical diplopia, decreased of visual acuity of right eye, and disseminated varicella zoster virus (VZV) infection with predominant skin lesions distributed along the ophthalmic division of the right trigeminal nerve. Cerebrospinal fluid (CSF) testing revealed meningitis and positive polymerase chain reaction (PCR) for VZV, and a brain MRI scan showed a right occipital hemorrhagic lesion; thus, she was diagnosed with disseminated VZV infection with neurological involvement. She received intravenous acyclovir for 10 days. One month later, a physical examination was unremarkable and she was asymptomatic, but control brain MR angiography showed stenosis of the right internal carotid and the right middle cerebral artery, compatible with VZV vasculopathy. The PCR for VZV turned negative in CSF but the titers of anti-VZV IgG antibodies in CSF were high, and no increase of plasma autoimmune biomarkers were detected at any time in the course of the clinical evolution. CONCLUSIONS Discordance between imaging findings and clinical manifestations can appear in intracerebral VZV vasculopathy. A differential diagnosis is mandatory, especially if there is underlying immunosuppression.

Topics: Acyclovir; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lupus Erythematosus, Systemic; Magnetic Resonance Imaging; Middle Aged

A 79-year-old man presented with chest and back pain on the right side but with no cutaneous lesions. He had received oral corticosteroids and immunosuppressants for systemic lupus erythematosus. He had spastic paraplegia, sensory disturbance in the lower limbs, and dysfunction of the bladder and bowel. He showed mononuclear-dominant pleocytosis and elevated proteins in the cerebrospinal fluid (CSF), and a decreased CSF/blood glucose ratio. Although polymerase chain reaction techniques found no varicella-zoster virus (VZV) DNA, VZV IgG antibodies were elevated in both the serum and CSF, and the VZV IgG index was dramatically elevated. MRI revealed no lesions in the brain or spine. However, somatosensory evoked potentials in the tibial nerve showed abnormal prolongation of the central sensory conduction time. We diagnosed the patient with acute myelitis associated with zoster sine herpete (ZSH). He received acyclovir and intravenous methylprednisolone pulse therapy in the early stage, and his symptoms and CSF findings completely recovered. We conclude that acute myelitis associated with ZSH should be treated as soon as possible because VZV infection may induce necrotizing myelitis if the treatment is delayed.

Topics: Acute Disease; Acyclovir; Aged; Antiviral Agents; Biomarkers; Diffusion Magnetic Resonance Imaging; Early Diagnosis; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunoglobulin G; Lupus Erythematosus, Systemic; Male; Methylprednisolone; Myelitis; Pulse Therapy, Drug; Time Factors; Treatment Outcome; Zoster Sine Herpete

Acyclovir has been used in the treatment of herpes simplex and varicella zoster viral infections for over 30 years. The side effects of oral treatment at standard doses are rare and include headache, diarrhoea, dizziness and malaise. We report a patient with a new diagnosis of systemic lupus erythematosus (SLE) who developed thrombocytopaenia within days on a therapeutic dose with acyclovir. Prompt discontinuation of acyclovir and treatment with intravenous immunoglobulin resulted in reversal of the above potentially serious complication. Therefore a high index of suspicion should be exercised in patients with SLE who require treatment with acyclovir for herpes viral infections. In these patients regular platelet count measurement should be considered while on treatment with the above antiviral agent.

Topics: Acyclovir; Comorbidity; Female; Herpes Zoster; Humans; Immunoglobulins, Intravenous; Lupus Erythematosus, Systemic; Middle Aged; Thrombocytopenia; Treatment Outcome

The aim of this multicenter study in a large childhood-onset systemic lupus erythematosus (cSLE) population was to assess the herpes zoster infection (HZI) prevalence, demographic data, clinical manifestations, laboratory findings, treatment, and outcome.. A retrospective multicenter cohort study (Brazilian cSLE group) was performed in ten Pediatric Rheumatology services in São Paulo State, Brazil, and included 852 cSLE patients. HZI was defined according to the presence of acute vesicular-bullous lesions on erythematous/edematous base, in a dermatomal distribution. Post-herpetic neuralgia was defined as persistent pain after one month of resolution of lesions in the same dermatome. Patients were divided in two groups for the assessment of current lupus manifestations, laboratory findings, and treatment: patients with HZI (evaluated at the first HZI) and patients without HZI (evaluated at the last visit).. The frequency of HZI in cSLE patients was 120/852 (14%). Hospitalization occurred in 73 (61%) and overlap bacterial infection in 16 (13%). Intravenous or oral aciclovir was administered in 113/120 (94%) cSLE patients at HZI diagnosis. None of them had ophthalmic complication or death. Post-herpetic neuralgia occurred in 6/120 (5%). After Holm-Bonferroni correction for multiple comparisons, disease duration (1.58 vs 4.41 years, p < 0.0001) was significantly lower in HZI cSLE patients compared to those without HZI. Nephritis (37% vs 18%, p < 0.0001), lymphopenia (32% vs 17%, p < 0.0001) prednisone (97% vs 77%, p < 0.0001), cyclophosphamide (20% vs 5%, p < 0.0001) and SLE Disease Activity Index 2000 (6.0 (0-35) vs 2 (0-45), p < 0.0001) were significantly higher in the former group. The logistic regression model showed that four independent variables were associated with HZI: disease duration < 1 year (OR 2.893 (CI 1.821-4.597), p < 0.0001), lymphopenia <1500/mm(3) (OR 1.931 (CI 1.183-3.153), p = 0.009), prednisone (OR 6.723 (CI 2.072-21.815), p = 0.002), and cyclophosphamide use (OR 4.060 (CI 2.174-7.583), p < 0.0001).. HZI is an early viral infection in cSLE with a typical dermatomal distribution. Lymphopenia and immunosuppressive treatment seem to be major factors underlying this complication in spite of a benign course.

Topics: Acyclovir; Adolescent; Adult; Age of Onset; Antiviral Agents; Brazil; Child; Child, Preschool; Cyclophosphamide; Female; Herpes Zoster; Hospitalization; Humans; Immunosuppressive Agents; Infant; Logistic Models; Lupus Erythematosus, Systemic; Lymphopenia; Male; Nephritis; Prednisone; Retrospective Studies; Severity of Illness Index; Young Adult

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

A woman with severe and longstanding systemic lupus erythematosus presented with a 1-week history of fever up to 38°C and pain in her right flank. Computed tomography scan of the chest revealed interstitial infiltrates and multiple nodules. Bronchoalveolar lavage did not show any inflammatory cells. Gram stain and cultures for aerobic and anaerobic bacteria, fungi, and Nocardia; acid-fast staining; polymerase chain reaction for tuberculosis, cytomegalovirus, herpesvirus 6, and parvovirus B19; and IF staining for pneumocystic and Legionella antigen were all negative. Transbronchial biopsy was nondiagnostic. Open lung biopsy with polymerase chain reaction and immunohistochemistry analyses revealed herpes simplex virus 1 infection. Acyclovir therapy was initiated and was followed by significant improvement. Herpes simplex virus 1 infection (although unusual) should be considered in patients with systemic lupus erythematosus with an atypical clinical presentation.

Topics: Acyclovir; Antiviral Agents; Biopsy; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Lung; Lupus Erythematosus, Systemic; Middle Aged; Pneumonia; Treatment Outcome

A 52-year-old woman with a 6-year history of systemic lupus erythematosus (SLE) developed acute abdominal pain, nausea, vomiting, and diarrhea accompanied by hypocomplementemia. Herpes simplex virus (HSV) esophagitis and lupus enteritis were diagnosed on the basis of the results of endoscopic and histological examinations and abdominal computed tomography (CT) findings. Treatment with acyclovir followed by high-dose intravenous steroids improved her symptoms. To our knowledge, this is the first case of simultaneous HSV esophagitis and lupus enteritis.

Topics: Acyclovir; Antiviral Agents; Drug Therapy, Combination; Enteritis; Esophagitis; Female; Glucocorticoids; Herpes Simplex; Humans; Lupus Erythematosus, Systemic; Methylprednisolone; Middle Aged; Pulse Therapy, Drug; Simplexvirus; Treatment Outcome

Topics: Acyclovir; Biopsy; Fatal Outcome; Female; Follow-Up Studies; Glucocorticoids; Humans; Lupus Erythematosus, Systemic; Lupus Nephritis; Sweet Syndrome; Young Adult

Topics: Acyclovir; Antiphospholipid Syndrome; Antiviral Agents; Drug Therapy, Combination; Female; Herpes Zoster; Humans; Immunosuppressive Agents; Infusions, Intravenous; Lupus Erythematosus, Systemic; Middle Aged; Mycophenolic Acid; Necrosis; Prednisone; Skin

Topics: Acyclovir; Adult; Antiviral Agents; Biopsy; Female; Herpes Simplex; Humans; Lupus Erythematosus, Systemic; Skin; Treatment Outcome; Valacyclovir; Valine; Vasculitis

Topics: Acyclovir; Adolescent; Antiviral Agents; Aspergillosis; Azathioprine; Brain; Chickenpox; Disseminated Intravascular Coagulation; Fatal Outcome; Female; Humans; Immunosuppressive Agents; Lung; Lupus Erythematosus, Systemic; Lymphohistiocytosis, Hemophagocytic; Meninges; Multiple Organ Failure; Myocardium; Opportunistic Infections; Prednisolone

We address the relationship between reactive hemophagocytic syndrome (RHS), systemic lupus erythematosus (SLE) activity, and treatment in 4 female patients with SLE. Febrile pancytopenia was related to cytologically proven RHS in all patients. Followup was 45+/-7 months from RHS onset. No causal infection could be identified. Outcome could be classified as: (1) RHS onset during a SLE flare and complete efficacy of high dose steroids; (2) death despite therapy for concomitant severe RHS and active SLE; (3) severe RHS in inactive SLE under immunosuppressants, with remission after steroid tapering and cyclophosphamide withdrawal. Three patients were treated with intravenous IgG. We conclude that (1) when SLE is active, RHS should be considered a specific manifestation and treated with steroids; (2) RHS occurring in otherwise inactive SLE might be related to iatrogenic immunosuppression; (3) intravenous IgG treatment might be indicated in both situations.

Topics: Acyclovir; Adult; Anti-Bacterial Agents; Blood Component Transfusion; Combined Modality Therapy; Cyclophosphamide; Fatal Outcome; Female; Follow-Up Studies; Glucocorticoids; Histiocytosis, Non-Langerhans-Cell; Humans; Immunoglobulins, Intravenous; Lupus Erythematosus, Systemic; Syndrome; Treatment Outcome

Topics: Acyclovir; Antitubercular Agents; Cyclosporine; Female; Fever; Herpesvirus 4, Human; Humans; Immunosuppression Therapy; Kidney Transplantation; Lupus Erythematosus, Systemic; Lupus Nephritis; Lymphoma; Middle Aged; Prednisone

A 31-year-old woman with systemic lupus erythematosus (SLE) developed meningoencephalitis, followed by transverse myelitis. The clinical picture was otherwise not consistent with a lupus flare. Extensive diagnostic evaluation was unrevealing. Acute visual loss ensued, associated with an unusual pattern of retinitis. Endoretinal biopsy established the diagnosis of herpesvirus infection. Reinstitution of antiviral therapy, and optic nerve sheath decompression, led to resolution of neurologic deficits and partial return of vision. Our report is the first that describes a patient with SLE with herpes meningoencephalitis, transverse myelitis, and rapidly progressive outer retinal necrosis, diagnosed antemortem by endoretinal biopsy, and successfully treated with acyclovir and optic nerve fenestration.

Topics: Acyclovir; Adult; Biopsy; Central Nervous System Diseases; Combined Modality Therapy; Female; Herpesviridae Infections; Humans; Lupus Erythematosus, Systemic; Meningoencephalitis; Myelitis, Transverse; Opportunistic Infections; Retinitis

We describe the case history of a 40-year-old, negroid woman with systemic lupus erythematosus who acquired a severe cytomegalovirus infection on immunosuppression; this infection was successfully treated with ganciclovir. New ideas in the management of CMV infections in immuno-compromised hosts are discussed. The traditional diagnostics are unsatisfactory, antibody detection being very insensitive and culture techniques too slow. A new diagnostic approach by detection of the immediate early antigens of the cytomegalovirus (CMV-IEA) using monoclonal antibodies is fast and reliable (sensitivity 93%, specificity 92%), even in case of immuno-deficiency. Finally we discuss the efficacy of the antiviral agent ganciclovir in the management of severe CMV infections.

Topics: Acyclovir; Adult; Antigens, Viral; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immediate-Early Proteins; Immunosuppressive Agents; Lupus Erythematosus, Systemic

A 15-year-old girl with systemic lupus erythematosus suddenly developed fever, meningismus, and herpes zoster. Within 48 hours, transverse myelitis developed at the level of the nerve root involvement of the herpes zoster. Since both systemic lupus erythematosus and varicella-zoster have been reported to cause myelitis, therapy was initiated for both. The rapid and simultaneous resolution of both the herpes zoster and the neurologic deficits strongly supports the causal association of both with varicella-zoster. This is the second reported case of herpes zoster-associated transverse myelitis in a patient with systemic lupus erythematosus.

Topics: Acyclovir; Adolescent; Amphotericin B; Dexamethasone; Female; Herpes Zoster; Humans; Lupus Erythematosus, Systemic; Myelitis; Myelitis, Transverse

In this article, we report a case of third-trimester disseminated herpes simplex virus (HSV) infection in an immunocompromised gravida who was treated with parenteral acyclovir. Rapid resolution of lesions occurred, and the fetus was delivered at term without evident abnormalities. Of the four previous reports on this therapy, there has been one maternal death and survival of all neonates. Acyclovir should be considered in the treatment of disseminated HSV infection in pregnancy.

Topics: Acyclovir; Adult; Female; Herpes Simplex; Humans; Immune Tolerance; Lupus Erythematosus, Systemic; Pregnancy; Pregnancy Complications, Infectious

Four immunosuppressed patients are described with chronic ulcerative herpes simplex virus infection in the sacral and perianal area. Three of these patients were evaluated for decubitus ulcers. Prompt diagnosis was possible when the characteristic morphologic features were recognized and when viral culture and Tzanck smear specimens were obtained. Previously reported cases are reviewed as well. Chronic mucocutaneous herpes simplex infections are complications of immunocompromised hosts and should be recognized early if appropriate therapy is to be initiated.

Topics: Acyclovir; Adult; Anus Diseases; Female; Glomerulosclerosis, Focal Segmental; Herpes Simplex; Humans; Immunosuppression Therapy; Leukemia, Lymphoid; Lupus Erythematosus, Systemic; Male; Middle Aged; Sacrococcygeal Region

Topics: Acyclovir; Ampicillin; Child; Child, Preschool; Cloxacillin; Drug Therapy, Combination; Female; Herpes Zoster; Herpes Zoster Ophthalmicus; Humans; Injections, Intravenous; Lupus Erythematosus, Systemic; Nephrotic Syndrome

Thirty-two episodes of herpes simplex virus infection in four immunodeficient patients with frequent recurrences were successfully treated with oral acyclovir, one capsule five times a day for 5 days. In 23 of these episodes, the treatments were extended for 1 to 6 months using two to five capsules a day with the aim of suppressing expected recurrences. In these patients, who routinely had more than one recurrence per month before treatment, there were only six outbreaks during more than 60 patient-months of suppressive therapy. Infection always recurred after treatments were completed, but the time to recurrence was shorter after treatments with two acyclovir capsules per day than after treatments with five capsules per day (p less than 0.001).

Topics: Acyclovir; Administration, Oral; Adult; Drug Administration Schedule; Female; Herpes Simplex; Hodgkin Disease; Humans; Immunologic Deficiency Syndromes; Lupus Erythematosus, Systemic; Male; Recurrence