![]() Eleven days prior to admission, fever and headache were noted, followed by right neck pain and earache. He had been taking trimethoprim-sulfamethoxazole for the prevention of pneumocystis pneumonia. Renal function had been stable with immunosuppressive therapy including prednisolone 5 mg/day, tacrolimus 1.5 mg/day (serum trough level 5.5 ng/mL), and mycophenolate mofetil 1000 mg/day. In this report, we also conducted a literature review of kidney transplant patients who developed pneumonia or CNS infection caused by VZV, and divided them according to whether the eruption preceded or followed the organ lesions, and then compared them to identify any significant differences in their clinical features and outcome.Ī 50-year-old man, who had undergone living-donor kidney transplantation for autosomal dominant polycystic kidney disease 2 years previously, was admitted to our hospital because of fever, wet cough, dyspnea, vesicles on the right external ear and diplopia. In this case, early diagnosis was difficult because diverse symptoms/signs appeared prior to the typical skin eruption. Polymerase chain reaction (PCR) of sputum supported the diagnosis of varicella pneumonia, and administration of acyclovir and glucocorticoid led to an almost complete recovery. We experienced a living-donor kidney transplantation patient who had varicella pneumonia, meningitis and multiple cranial nerve palsy due to reactivation of VZV. However, several cases of VZV infection in immunocompromised hosts with a fatal outcome due to a delayed diagnosis because of the lack of typical vesicular eruptions at onset have been reported. Early diagnosis and swift treatment are important for primary infection of adults or reactivation in an immunocompromised host because they are more likely to be associated with organ lesions such as pneumonia and central nervous system (CNS) infection, associated with a poorer prognosis. Latent infection of VZV occurs in sensory nerve ganglia, and reactivation in elderly persons causes herpes zoster in the innervated area. Varicella, which often occurs in childhood, is characterized by an acute febrile vesicular rash with a favorable prognosis due to primary infection with varicella-zoster virus (VZV). ![]() The efficacy of inactivated recombinant zoster vaccine in immunocompromised individuals at high risk of reactivation of VZV also needs to be examined in the future. Although the diagnosis of varicella pneumonia is generally made by PCR test of bronchoalveolar lavage fluid, our case experience suggests that the less invasive PCR test of sputum may be useful for rapid and accurate diagnosis. Therefore, it should be kept in mind that kidney transplant patients are always at high risk of VZV infection, as early recognition and treatment of the disease improves its prognosis. Furthermore, there may be a wide variety of intervals from kidney transplantation to VZV infection (including both primary infection and reactivation of VZV), ranging from 2 weeks to 11 years. It showed that there are cases in which eruptions appeared upto 21 days after the onset of the disease and others in which eruptions did not appear at any time during the clinical course. We also conducted a literature review of adult cases with pneumonia or CNS infection caused by VZV after kidney transplantation. We herein report a case of pneumonia and central nervous system (CNS) infection caused by reactivation of VZV in a 50-year-old man who had received a living-donor kidney transplant. Varicella-zoster virus (VZV) typically causes herpes zoster in the elderly due to reactivation, but immunocompromised individuals may develop organ damage such as pneumonia with a poor prognosis.
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