Abstract: SA-PO1141
Not a Classic Chickenpox Infection: Retinal Necrosis in a Renal Transplant Patient
Session Information
- Transplant Trainee Case Reports
November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1902 Transplantation: Clinical
Authors
- Lopez vega, Keysha, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Marquez Pantoja, Mariela, University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Cintron-Rosa, Fatima B., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Ocasio Melendez, Ileana E., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
- Rivera-Bermudez, Carlos G., University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
Introduction
Viruses are common opportunistic infection among kidney transplant patients. Varicella-zoster virus (VZV) is often reactivated at 6 to 12 months after transplant as Herpes Zoster (HZ). Primary VZV infection is less common and is more severe. We present the case of a kidney transplant recipient with a severe complication of primary VZV infection.
Case Description
A 42-year-old-woman with hypothyroidism, post-transplant diabetes mellitus, end stage kidney disease due to renal agenesis status post kidney transplant (2006) on Tacrolimus 2mg in the morning and 1.5 mg in the evening, mycophenolic acid 360 mg thrice daily, levothyroxine and insulin regimen was admitted to our institution after ophthalmology evaluation. Four weeks prior to admission she was hospitalized at another institution due to primary VZV infection, reported relative with HZ and no prior VZV vaccination, she was treated with intravenous (IV) acyclovir and discharged home with oral (PO) acyclovir after no new skin lesions occurred. Two weeks after initial onset she developed a rash at the dorsum of the hands and left eye blurry vision. She was evaluated by ophthalmology and was admitted with left acute retinal necrosis due to HZV. Evaluation was significant for no fever, no visible vesicular skin lesions but impaired left pupillary reflex and left facial nerve palsy. Laboratory results showed leukocytosis, creatinine level on baseline, 1.8 mg/dL, and hyperglycemia. She was started on acyclovir 1 gram IV every 8 hours, IV hydration and mycophenolic acid was discontinued. She received intravitreal ganciclovir every 48 hours for two weeks. After the second dose of gancylovir she noticed improvement of blurry vision and resolution of symptoms after first week of treatment. She was discharged home with PO acyclovir 800 mg every 4 hours and decreased mycophenolic acid dose to 180 mg twice daily.
Discussion
Our patient developed a rare complication of primary VZV infection, acute retinal necrosis, 13 years after kidney transplant. Recent studies show incidence of VZV after kidney transplant is less than 1%. This case emphasizes the importance of VZV vaccination in the pre-transplant period and vaccination of close contacts. Early and prompt intervention is needed in those patients with visual complications since they are at risk of vision loss.