acyclovir and Pancreatitis

Topics: Acute Disease; Acyclovir; Adult; Anti-Bacterial Agents; Antiviral Agents; Bacterial Infections; Cephalosporins; Ciprofloxacin; Female; Humans; Male; Pancreatitis; Retrospective Studies; Tertiary Care Centers; Treatment Outcome; Virus Diseases

Topics: Acyclovir; Aged; Antineoplastic Agents; Antiviral Agents; Bridged Bicyclo Compounds, Heterocyclic; Exanthema; Female; Hepatitis; Herpesvirus 3, Human; Humans; Immunocompromised Host; Leukemia, Lymphocytic, Chronic, B-Cell; Opportunistic Infections; Pancreatitis; Recurrence; Sulfonamides; Treatment Outcome; Varicella Zoster Virus Infection

We report a case of fatal disseminated varicella zoster virus (VZV) with delayed-onset rash in a 66-year-old female more than 2 years following uncomplicated deceased donor renal transplantation. Whilst on a stable regimen of maintenance immunosuppression, the patient presented with chest and abdominal pain with concomitant hepatitis and pancreatitis. After pursuing multiple other potential causes of her symptoms, the correct diagnosis of VZV was only suspected after the development of a widespread vesicular rash-11 days after her initial symptoms. Despite antiviral therapy and inotropic support in the intensive care unit, the patient died. Simultaneous VZV hepatitis and pancreatitis in solid organ transplant recipients is uncommon. The new inactivated VZV vaccines have the potential to prevent post-transplant infections, with promising early clinical data on safety and efficacy in renal transplant recipients. VZV is an important preventable infection that should be considered in immunocompromised patients, even in the absence of rash.

Topics: Acyclovir; Aged; Antiviral Agents; Exanthema; Fatal Outcome; Female; Hepatitis; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Kidney Transplantation; Pancreatitis

A 15-year-old girl with a diagnosis of varicella zoster virus (VZV) presented to hospital with severe abdominal pain. This patient was immunocompetent and found to have acute pancreatitis in association with VZV. She responded well to intravenous acyclovir and supportive treatment. A review of the literature for the management of pancreatitis associated with VZV suggests treatment with acyclovir, as it appears to reduce hospital stay and symptoms. The exact benefit is yet to be quantified. Importantly, this diagnosis should be considered in children who have VZV associated with abdominal pain.

Topics: Acyclovir; Adolescent; Antiviral Agents; Chickenpox; Female; Herpesvirus 3, Human; Humans; Immunocompetence; Pancreatitis

Varicella-zoster virus (VZV) usually causes localized zoster in adults. However, in immunocompromised patients, it can cause systemic infection accompanied by complications such as pneumonia, encephalitis, and hepatitis. Although most of critically ill patients in intensive care unit (ICU) are immunologically compromised, they are usually not considered to be at risk for systemic VZV infection.We report two cases of systemic VZV infection occurring in critically ill patients in an ICU. One patient was a 69-year-old man with Streptococcus pneumoniae-induced purpurafulminans, and the other was a 75-year-old woman with severe acute pancreatitis. During the clinical course in the ICU, characteristic vesicles with umbilical fossa appeared diffusely and bilaterally on their face, trunk, and extremities. VZV-specific IgG levels were confirmed to be elevated compared to that of the pre-onset, and a diagnosis of recurrent VZV infection was made in both patients. The patients were treated at the same ICU but did not coincide with each other; therefore a cross-infection was unlikely. They were treated with intravenous acyclovir, but the latter patient eventually died of respiratory failure.VZV infection can cause a number of serious complications, and can lead to death in some patients. Early detection and proper treatment are needed to prevent the infection from spreading out and save the patients. It might be necessary to consider antiviral prophylaxis against VZV infection for a part of critically ill patients in ICU, although the effectiveness of this approach is yet to be established.

Topics: Acyclovir; Administration, Intravenous; Aged; Animals; Antibodies, Viral; Critical Illness; Female; Herpesvirus 3, Human; Humans; Immunoglobulin G; Intensive Care Units; Male; Middle Aged; Pancreatitis; Pneumococcal Infections; Purpura Fulminans; Viremia

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

Chicken pox is a benign self limited disease. But it may rarely be complicated with acute pancreatitis in otherwise healthy patient. We present a case of varicella pancreatitis and its marked recovery with acyclovir.

Topics: Acyclovir; Adult; Antiviral Agents; Chickenpox; Humans; Immunocompetence; Male; Pancreatitis; Young Adult

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

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Herpes Zoster; Humans; Male; Pancreatitis; Treatment Outcome; Ultrasonography

A 43-year-old homosexual man was hospitalized in April 1988 because of acute epigastric pain. It was known that he had had a HIV infection for a year, and in April 1988 it was defined as stage Walter Reed I. Acute, exudative, nonspecific pancreatitis was diagnosed. Three weeks later cerebral symptoms (disturbances of consciousness), hypoacusis, and impaired vision developed. The ocular fundus displayed areas of edema and whitish clouding in the retina, first in the left eye and later also in the right. These were initially assumed to be anemic infarctions until the differential diagnosis of acute retinal necrosis with possible herpesvirus infection was made. On the basis of ophthalmoscopic findings cytomegalovirus retinitis appeared improbable. Serologic examinations showed increased levels of IgG antibody titers of cytomegalovirus and herpes simplex virus (both 1:20,000). Therapy with intravenous infusions of Acyclovir was instituted (1500 mg/d). After a few days the patient regained consciousness as well as his hearing and vision. There was complete resolution of the retinal exudates. This excellent therapeutic result of Acyclovir therapy confirmed the diagnosis of acute retinal necrosis syndrome, identified the cerebral symptoms as herpes encephalitis, and explained the entire disease process as the first opportunistic infection in HIV infection, i.e., by that time the patient had developed stage Walter Reed 6 (AIDS). Problems of differential diagnosis and the therapeutic schedule with Acyclovir are discussed.

Topics: Acquired Immunodeficiency Syndrome; Acute Disease; Acyclovir; Adult; Encephalitis; Herpes Simplex; Humans; Male; Ophthalmoscopy; Pancreatitis; Referral and Consultation; Retinal Necrosis Syndrome, Acute