Abstract: SA-PO1161
A Preventable Complication in Transplantation: Disseminated Varicella Zoster Virus with Pneumonitis and Syndrome of Inappropriate Antidiuretic Hormone Secretion: A Case and Literature Review
Session Information
- Transplantation: Clinical - Infectious Diseases
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Prikis, Marios, University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States
- Haq, Kanza, University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States
- Montejo, Carlos, University of Vermont The Robert Larner MD College of Medicine, Burlington, Vermont, United States
Introduction
Solid organ transplant recipients are at increased risk for severe infections due to chronic immunosuppression. Varicella zoster virus (VZV) reactivation is typically localized but may progress to disseminated, multi-organ disease in immunocompromised patients. Although historically difficult to prevent, the introduction of the recombinant zoster vaccine (RZV) has made VZV a largely preventable complication in transplant populations. Despite this, gaps in vaccination and recognition persist.
Case Description
A 65-year-old male with a 34-year history of deceased-donor kidney transplantation (stage IV CKD on cyclosporine and mycophenolate mofetil) presented with altered mental status one week after a dermatomal rash treated outpatient. Initial evaluation revealed acute kidney injury, metabolic acidosis, hyperkalemia, and encephalopathy. VZV PCR from lesions and cerebrospinal fluid confirmed disseminated infection with CNS involvement. Immunosuppression was reduced and intravenous acyclovir initiated. The clinical course was complicated by acute hypoxic respiratory failure with imaging consistent with VZV pneumonitis and severe hyponatremia (Na 118 mmol/L) meeting criteria for syndrome of inappropriate antidiuretic hormone secretion (SIADH), likely triggered by pulmonary inflammation. Management included hypertonic saline, fluid restriction, and diuretics. Renal function peaked at creatinine 7.64 mg/dL before improving. The patient was discharged on oral antiviral therapy with normalization of sodium and near-baseline renal function.
Discussion
Disseminated VZV in kidney transplant recipients remains a rare but high-morbidity condition with potential for multi-organ involvement, including pulmonary disease and electrolyte disturbances. Review of prior cases demonstrates consistent reports of severe outcomes, many occurring before widespread availability of recombinant vaccination. This case uniquely highlights the convergence of pneumonitis and SIADH while reinforcing a critical shift in transplant care. VZV is now a preventable complication. These findings underscore the need for routine vaccination with RZV vaccine in eligible transplant recipients, improved interdisciplinary coordination to ensure preventive care, and heightened clinical suspicion for atypical presentations to reduce morbidity and mortality.