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KMID : 1144320190510030310
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2019 Volume.51 No. 3 p.310 ~ p.314
Successful Treatment of Fulminant Hepatitis due to Varicella Zoster Virus using Immunoglobulin in a Kidney Transplant Patient
Hsing Li-Chang

Kim Ji-Yeun
Kwon Ji-Soo
Shin Eui-Cheol
Kim Sung-Han
Abstract
The clinical benefit of adjuvant intravenous immunoglobulin (IVIG) therapy is controversial in immunocompromised patients with severe varicella. A twenty-one-year-old woman who had received a kidney transplant one year earlier presented with fever and generalized rash for 5 days. Initial immunoglobulin M (IgM) and IgG for varicella zoster virus (VZV) were negative; however, the patient was diagnosed with varicella with fulminant hepatitis because VZV-specific PCR from skin vesicles and blood was positive. The patient received intravenous acyclovir and 5-day IVIG. The decline of plasma viral load was steeper (beta coefficient ?0.446) during IVIG therapy than after the therapy (beta coefficient ?0.123) (P = 0.04), while VZV glycoprotein IgG titers and VZV-specific T cell responses were not detected during the 5-day IVIG therapy. The patient improved without any complications. This case provides an experimental evidence that adjuvant IVIG can significantly reduce viral load in immunocompromised patients with severe varicella.
KEYWORD
Varicella zoster virus, Fatal hepatitis, Intravenous immunoglobulin
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