Korean J Transplant.  2022 Sep;36(3):221-225. 10.4285/kjt.22.0009.

Fulminant hepatitis and myocarditis associated with varicella zoster virus infection in a kidney transplant recipient: a case report

• Park J
• Kang M
• Ha J
• Lee H

• KMID: 2533960
• DOI: http://doi.org/10.4285/kjt.22.0009

Abstract

Varicella zoster virus (VZV) infection can follow a virulent course, leading to possible infection-related mortality in immunocompromised hosts. Visceral disseminated VZV infection is a rare disease with a high mortality rate in immunocompromised patients. We present a case of acute liver failure and acute myocarditis due to visceral disseminat-ed VZV infection in an immunocompromised patient who had recently received kidney transplantation and who subsequently showed dramatic improvement after treatment with intravenous acyclovir and intravenous immunoglobulin. Severe epigastric pain preceded the vesicular skin lesions; therefore, the diagnosis and treatment could have been delayed. Such delays have caused mortality in most previous cases. Therefore, it is necessary to consider visceral disseminated viral infection in the differential diagnosis of immunocompromised patients when multi-organ failure progresses with an unknown cause.

Keyword

Varicella zoster virus infection; Liver failure; Myocarditis; Kidney transplantation; Case report

Figure

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  Fig. 1 Changes in aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin levels during hospitalization. Acyclovir was administered on the fourth day of hospitalization and intravenous immunoglobulin was administered on the fifth day of hospitalization. After the sixth day of hospitalization, AST and ALT levels began to decrease. Hepatitis A virus immunoglobulin G antibody and hepatitis A virus immunoglobulin M antibody were examined by radioimmunoassay. Hepatitis B surface antigen was examined by chemiluminescent microparticle immunoassay. Anti-hepatitis C virus and varicella zoster virus immunoglobulin M antibody were examined by enzyme-linked immunosorbent assay. Cytomegalovirus antigen was examined by monoclonal antibody stain. Polyomavirus examined by real-time polymerase chain reaction. Varicella zoster virus immunoglobulin G antibody was examined by chemiluminescent immunoassay.

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