valacyclovir and Vasculitis

Vasculitis associated with sarcoid granulomas is an uncommon phenomenon. A 72-year-old female presented with an expanding region of circumscribed alopecia and scalp atrophy of 2 months duration. Biopsy showed non-caseating granulomas, dermal thinning, loss of follicles, fibrosis and muscular vessels disrupted by mixed lymphocyte, macrophage and giant-cell infiltrates. Affected vessels had loss and fragmentation of the elastic lamina, fibrous replacement of their walls and luminal stenosis (endarteritis obliterans). Dermal and vascular advential intralymphatic granulomas and lymphangiectases were found by D2-40 expression, suggesting lymphatic obstruction and poor antigen clearance. No evidence of a post-zoster eruption, systemic sarcoidosis or systemic giant-cell arteritis was found. Two years later, prednisone had halted - but not reversed - progression of her alopecia. Review of the literature showed two types of vasculitis associated with sarcoid granulomas: (i) acute, self-limited leukocytoclastic vasculitis and (ii) chronic granulomatous vasculitis (GV). Persistence of non-degradable material or antigen contributes to the pathogenesis of granulomatous inflammation. In this case, lymphatic obstruction probably impeded clearance of nonimmunologic and/or immunologic stimuli permitting and sustaining the development of sarcoid granulomas and sarcoid GV, ultimately causing scarring alopecia and cutaneous atrophy.

Topics: Acyclovir; Adult; Aged; Alopecia Areata; Antibodies, Monoclonal, Murine-Derived; Antiviral Agents; Biopsy; Cytokines; Female; Glucocorticoids; Granuloma; Humans; Lymphocytes; Male; Middle Aged; Prednisone; Sarcoidosis; Scalp; Skin Diseases; Valacyclovir; Valine; Vasculitis; Vasculitis, Central Nervous System

Infection is the leading cause of death in antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Expansion of CD4+CD28null T cells is associated with increased risk of infection and mortality, but is only present in cytomegalovirus (CMV)-seropositive individuals. We hypothesized that subclinical CMV reactivation drives CD4+CD28null T-cell expansion, that this is associated with impaired immune response to heterologous antigens, and that antiviral therapy may ameliorate this.. In a proof-of-concept open-label clinical trial, 38 CMV-seropositive AAV patients were randomized to receive valacyclovir for 6 months or no intervention. CMV reactivation was measured monthly in plasma and urine. CD4+CD28null T cells were enumerated at baseline and at 6 months. At 6 months, 36 patients were vaccinated with a 13-valent pneumococcal vaccine. Serotype-specific immunoglobulin G was assayed before and 4 weeks postvaccination to calculate the antibody response ratio.. Valacyclovir treatment suppressed subclinical CMV reactivation and reduced CD4+CD28null T-cell proportion. CD4+CD28null T-cell reduction correlated with improved vaccine response, whereas CMV reactivation associated with reduced response to vaccination. Furthermore, expansion of CD4+CD28null T cells was associated with a reduction in the functional capacity of the CD4 compartment.. Suppression of CMV may improve the immune response to a T-cell-dependent pneumococcal vaccination in patients with AAV, thus offering potential clinical benefit.. NCT01633476.

Topics: Aged; Antibodies, Antineutrophil Cytoplasmic; Antibodies, Viral; Antiviral Agents; CD28 Antigens; CD4-Positive T-Lymphocytes; Cytomegalovirus; Female; Humans; Male; Middle Aged; Pneumococcal Infections; Pneumococcal Vaccines; Vaccination; Valacyclovir; Vasculitis; Viral Load

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

Intracranial aneurysms in the pediatric population are relatively rare entities. Immunocompromised patients (often from HIV/AIDS or pharmacological immunosuppression) represent a significant fraction of children with cerebral aneurysms. One proposed mechanism of aneurysm formation in these patients is from direct infection of the affected arteries. In this study, the authors report on a case of a 14-year-old girl with common variable immunodeficiency with T-cell dysfunction and a CSF polymerase chain reaction test positive for varicella-zoster virus who underwent evaluation for carotid and basilar artery fusiform aneurysms.

Topics: Acyclovir; Adolescent; Aneurysm; Angiography, Digital Subtraction; Antiviral Agents; Aspirin; Basilar Artery; Carotid Artery Diseases; Carotid Artery, Internal; Cerebral Angiography; Common Variable Immunodeficiency; Female; Herpes Zoster; Humans; Image Processing, Computer-Assisted; Intracranial Aneurysm; Magnetic Resonance Angiography; Platelet Aggregation Inhibitors; T-Lymphocytes; Tomography, X-Ray Computed; Valacyclovir; Valine; Vasculitis; Vertebral Artery

Topics: Acyclovir; Adult; Antiviral Agents; Female; Herpes Labialis; Humans; Mononeuropathies; Muscular Atrophy; Paresthesia; Peripheral Nerves; Tibial Neuropathy; Ulnar Neuropathies; Valacyclovir; Valine; Vasculitis; Wallerian Degeneration