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KMID : 1144320190510030310
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감염과 화학요법
2019 Volume.51 No. 3 p.310 ~ p.314
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Successful Treatment of Fulminant Hepatitis due to Varicella Zoster Virus using Immunoglobulin in a Kidney Transplant Patient
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Hsing Li-Chang
Kim Ji-Yeun
Kwon Ji-Soo
Shin Eui-Cheol
Kim Sung-Han
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Abstract
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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.
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KEYWORD
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Varicella zoster virus, Fatal hepatitis, Intravenous immunoglobulin
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