Korean J Pediatr.  2014 Aug;57(8):370-373.

Use of intravenous immunoglobulin in a disseminated varicella infection in an immunocompromised child

• Kim JH
• Kwon DH
• Bae EY
• Han SB
• Lee JW
• Chung NG
• Jeong DC
• Cho B
• Kang JH
• Kim HK

Abstract

Varicella-zoster virus infection can lead to severe illness in immunocompromised patients. Further the mortality rate of disseminated varicella infection is extremely high particularly in immunocompromised children. We report a case of disseminated varicella infection in a child with acute lymphoblastic leukemia who was receiving chemotherapy, but was initially admitted with only for acute abdominal pain. The patient rapidly developed severe complications, including acute respiratory distress syndrome, acute hepatitis, disseminated intravascular coagulation, and encephalopathy. Acyclovir is a highly potent inhibitor of varicella-zoster virus infection. However, owing to rapid disease progression, it might not be sufficient to control a disseminated varicella infection, especially in immunocompromised patients. Immunoglobulin neutralize virus invasion and suppress viremia, acting synergistically with acyclovir. In this case, early administration of acyclovir and a high-dose of immunoglobulin, combined with mechanical respiratory support, proved adequate for treatment of this severe illness.

Keyword

Varicella-zoster virus; Acyclovir; Immunoglobulin

MeSH Terms

Abdominal Pain
Acyclovir
Chickenpox*
Child*
Disease Progression
Disseminated Intravascular Coagulation
Drug Therapy
Hepatitis
Herpesvirus 3, Human
Humans
Immunocompromised Host
Immunoglobulins*
Mortality
Precursor Cell Lymphoblastic Leukemia-Lymphoma
Respiratory Distress Syndrome, Adult
Viremia
Acyclovir
Immunoglobulins