Fatal case of cutaneous-sparing orolaryngeal zoster in a renal transplant recipient

Transpl Infect Dis. 2017 Aug;19(4). doi: 10.1111/tid.12704. Epub 2017 Jun 1.

Abstract

Herpesvirus infections in solid organ transplant (SOT) recipients are a significant cause of morbidity and mortality. We report a case of herpes zoster (HZ) in a kidney transplant recipient while receiving belatacept, a CTLA-4 inhibitor that prevents acute rejection. The patient presented with oropharyngolaryngeal mucosal lesions that subsequently disseminated resulting in pneumonitis and meningo-encephalitis. Very late-onset HZ can occur and can present atypically in SOT recipients. Delayed recognition and treatment may result in poor outcomes, as illustrated by this case.

Keywords: disseminated VZV; kidney transplant; late-onset infection.

Publication types

  • Case Reports

MeSH terms

  • Abatacept / administration & dosage
  • Anti-Inflammatory Agents / therapeutic use
  • Antiviral Agents / therapeutic use
  • Autopsy
  • Fatal Outcome
  • Female
  • Herpes Zoster / diagnosis*
  • Herpes Zoster / etiology
  • Herpes Zoster / pathology
  • Herpes Zoster / virology
  • Herpesvirus 3, Human / isolation & purification*
  • Humans
  • Immunosuppressive Agents / administration & dosage
  • Kidney Transplantation / adverse effects*
  • Laryngeal Edema / diagnosis
  • Laryngeal Edema / pathology
  • Laryngeal Edema / virology*
  • Late Onset Disorders / diagnosis*
  • Late Onset Disorders / etiology
  • Late Onset Disorders / pathology
  • Late Onset Disorders / virology
  • Middle Aged
  • Prednisone / therapeutic use
  • Transplant Recipients

Substances

  • Anti-Inflammatory Agents
  • Antiviral Agents
  • Immunosuppressive Agents
  • Abatacept
  • Prednisone