acyclovir and Puerperal-Disorders

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Immunization, Passive; Infant, Newborn; Male; Pregnancy; Pregnancy Complications, Infectious; Puerperal Disorders

A young woman presented with a febrile illness in the third trimester of pregnancy. Laboratory investigation revealed severe acute hepatitis with thrombocytopenia and coagulopathy. Liver injury progressed despite emergent caesarian section and delivery of a healthy infant. Therefore, therapeutic plasma exchange (TPE) was performed on three consecutive days post-partum for a presumed diagnosis of acute liver failure (ALF) associated with pregnancy due to hemolysis, elevated liver enzymes, and low platelets (HELLP) or acute fatty liver of pregnancy (AFLP). Treatment with TPE was followed by biochemical and clinical improvement but during her recovery herpes simplex virus type 2 (HSV-2) infection was diagnosed serologically and confirmed histologically. Changes in the immune system during pregnancy make pregnant patients more susceptible to acute HSV hepatitis, HSV-related ALF, and death. The disease is characterized by massive hepatic inflammation with hepatocyte necrosis, mediated by both direct viral cytotoxicity and the innate humoral immune response. TPE may have a therapeutic role in acute inflammatory disorders such as HSV hepatitis by reducing viral load and attenuating systemic inflammation and liver cell injury. Further investigation is needed to clarify this potential effect. The roles of vigilance, clinical suspicion, and currently accepted therapies are emphasized.

Topics: Acute Disease; Acyclovir; Anti-Bacterial Agents; Antiviral Agents; Cesarean Section; Combined Modality Therapy; Dexamethasone; Emergencies; Female; Fetal Organ Maturity; Hepatitis, Viral, Human; Herpes Simplex; Humans; Hydrocortisone; Infant, Newborn; Liver Failure; Male; Plasma Exchange; Pregnancy; Pregnancy Complications; Pregnancy Complications, Infectious; Puerperal Disorders; Systemic Inflammatory Response Syndrome; Young Adult

Herpetic encephalitis (HSE) is one of the most severe infections of Central Nervous System (CNS). If not treated, it results in patient's death in 70% cases, although in properly treated cases the mortality rate is 30%. The most endangered group are patients with immunosuppression, including pregnant women and women in the peripartum period. We present a case of a young woman in puerperium period, who developed herpetic encephalitis. Despite proper treatment patient required long term hospitalization in ICU, where she was placed in pharmacological coma. Despite severe course of the disease no neurological sequelae were observed. The aim of this paper was to emphasize the necessity of immediate antiviral therapy with Acyclovir in all cases suspected of HSE. Additionaly HSE may progress rapidly and ICU treatment should be considered.

Topics: Acyclovir; Adult; Antiviral Agents; Encephalitis, Viral; Female; Herpesviridae Infections; Humans; Puerperal Disorders; Young Adult

A 46-year-old woman with a triplet pregnancy developed seizures, an oculogyric crisis and a homonymous hemianopia post-natally. Abnormal neuroimaging studies and lumbar puncture suggested possible cerebral vasculitis. Treatment with aciclovir and prednisolone resulted in a slow resolution of symptoms. This case highlights the difficulty in distinguishing eclampsia from rarer neurological causes of peripartum seizures.

Topics: Acyclovir; Anti-Inflammatory Agents; Cerebrospinal Fluid; Diagnosis, Differential; Eclampsia; Female; Hemianopsia; Humans; Leukocyte Count; Lymphocyte Count; Magnetic Resonance Angiography; Middle Aged; Prednisolone; Pregnancy; Puerperal Disorders; Seizures; Spinal Puncture; Tomography, X-Ray Computed; Triplets; Vasculitis, Central Nervous System

Facial diplegia is a rare event, most commonly of unknown origin. We report the case of a woman who presented bilateral Bell's palsy a few days after a normal delivery.. Five days after the delivery of gemellary pregnancy, a 34-year old woman developed complete bilateral facial palsy. No treatment was initially prescribed. She was first seen in our department two weeks after the onset of her illness. The diagnostic work-up was negative and we considered that our patient had bilateral Bell's palsy. Treatment with methylprednisolone and intravenous acyclovir, initiated since admission, have had very limited effect.. As has already been shown for facial palsy, idiopathic facial diplegia, although exceptional, seems to be more frequent during the last trimester of pregnancy and in the early puerperium. Seven cases have been reported in the literature over the last 30 years. We discuss here the pathophysiology.

Topics: Acute Disease; Acyclovir; Adult; Anti-Inflammatory Agents; Antiviral Agents; Bell Palsy; Chronic Disease; Diagnosis, Differential; Drug Therapy, Combination; Female; Humans; Magnetic Resonance Imaging; Methylprednisolone; Pregnancy; Puerperal Disorders; Risk Factors; Spinal Puncture; Twins

Delayed central neurological symptoms following herpes zoster ophthalmicus (HZO) such as "herpes zoster ophthalmicus and delayed contralateral hemiparesis" are considered to be due to ipsilateral intracranial vasculopathy. We experienced a rare case with cerebral infarction occurred in puerperium following HZO in late pregnancy. A healthy 30-year-old woman had left HZO at weeks 35 of gestation. She was given acyclovir (ACV) for external use and improved with small pigmentation on the left eye-lid. Seven weeks after the onset of HZO, she suddenly developed aphasia and right hemiparesis. Cerebral angiogram showed narrowing on M 1 segment of the ipsilateral middle cerebral artery. The occlusion was seen on peripheral portion of the angular artery on the same side. In cerebrospinal fluid (CSF), cell count was slightly elevated, but concentration of protein and sugar were normal. Varicella-zoster titer was increased in both serum and CSF. She was treated with intravenous ACV (1500 mg/day) for 10 days. On the next day after the treatment, the cell count was normalized and on 18th day, varicella-zoster titer was decreased in CSF. Higher brain function improved and no relapses occurred. This is a first case of delayed cerebral infarction occurring in puerperium preceded by herpes zoster ophthalmicus in late pregnancy, as far as we searched. We should treat carefully pregnant or lactating patients with HZO, considering delayed cerebral infarction.

Topics: Acyclovir; Adult; Antiviral Agents; Cerebral Infarction; Female; Herpes Zoster Ophthalmicus; Humans; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Trimester, Third; Puerperal Disorders