valacyclovir and Pneumonia

We present a case of a patient with hairy cell leukemia and pulmonary aspergillosis who developed a cycotic pulmonary artery aneurysm despite prolonged antifungal therapy. A review of the literature in regards to incidence, etiology, clinical manifestations and treatment options is included.

Topics: Abscess; Acyclovir; Amphotericin B; Aneurysm, Infected; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Agents; Antiviral Agents; Aspergillus; Caspofungin; Ceftazidime; Clindamycin; Echinocandins; Fluconazole; Humans; Leukemia, Hairy Cell; Lipopeptides; Male; Middle Aged; Mouth; Ofloxacin; Pneumonia; Pulmonary Artery; Pulmonary Aspergillosis; Valacyclovir; Valine; Vancomycin

HIV-related treatment and prevention strategies for opportunistic infections presented at the 1995 International Conference on Antimicrobial Agents and Chemotherapy (ICAAC) are highlighted. Research highlights include valaciclovir for CMV prophylaxis, oral ganciclovir for preventing CMV, resistant CMV, and cidofovir (HPMPC) for CMV. Other topics discuss treatments of Mycobacterium avium complex, opportunistic infections and HIV viremia; and reports on the effects of influenza and pneumococcal immunizations on HIV viral load.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Bacterial Vaccines; CD4 Lymphocyte Count; Cidofovir; Clinical Trials as Topic; Cytomegalovirus Infections; Cytosine; Drug Resistance, Microbial; Ganciclovir; HIV; Humans; Influenza Vaccines; Mycobacterium avium-intracellulare Infection; Organophosphonates; Organophosphorus Compounds; Pneumonia; Pneumonia, Pneumocystis; Randomized Controlled Trials as Topic; United States; Valacyclovir; Valine; Viremia

A 72-year-old woman with rheumatoid arthritis was treated with methotrexate (MTX) and iguratimod. Upon examination of a liver tumor, blisters due to varicella-zoster virus (VZV) infection were observed. Despite oral administration of valacyclovir, she developed varicella pneumonia and meningoencephalitis. A VZV antibody test revealed reinfection. The liver tumor shrank after discontinuance of MTX, and polymerase chain reaction revealed the reactivation of the Epstein-Barr virus (EBV). Therefore, we were unable to deny MTX-associated lymphoproliferative disorder (MTX-LPD). This is the first case of a complication of pneumonia and meningoencephalitis due to VZV reinfection and EBV reactivation.

Topics: Aged; Arthritis, Rheumatoid; Epstein-Barr Virus Infections; Female; Herpesvirus 3, Human; Herpesvirus 4, Human; Humans; Liver Neoplasms; Lymphoproliferative Disorders; Meningoencephalitis; Methotrexate; Pneumonia; Reinfection; Valacyclovir