Management of varicella infection during the course of inflammatory bowel disease.
OBJECTIVE
To study the natural history and outcome of varicella infection developing in steroid treated inflammatory bowel disease.


BACKGROUND
Varicella infection occurring in immunosuppressed or immunocompromised patients is a common problem with a significant mortality. Varicella infection during the course of inflammatory bowel disease has been reported in a small number of patients with at least one fatality.


METHODS
Four young patients with inflammatory bowel disease who developed varicella infection while on immunosuppressive therapy, steroids, or azathioprine were studied. In each patient the infection was severe, and the three most recently treated patients received acyclovir.


RESULTS
All four patients developed severe varicella infection while receiving immunosuppressive therapy for their disease. Three patients were treated with intravenous acyclovir with concomitant reduction of steroid dosage and recovered completely. One patient, treated in 1980 with antibiotics and reduction in steroids, did not receive acyclovir and also survived.


CONCLUSIONS
Varicella infection is a relatively uncommon occurrence in inflammatory bowel disease. If varicella infection occurs, prompt diagnosis and treatment with acyclovir and concomitant reduction in immunosuppressive therapy (reduction in steroid dosage and discontinuation of azathioprine) should be initiated immediately to limit viremia and avoid fatal complications.
Mouzas
I A
IA
Department of Gastroenterology, University Hospital, Heraklion, Greece.
Greenstein
A J
AJ
Giannadaki
E
E
Balasubramanian
S
S
Manousos
O N
ON
Sachar
D B
DB
D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001379:Azathioprine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D002423:Cause of Death; D002506:Cephalexin / Q000627:therapeutic use; D002511:Cephalosporins / Q000627:therapeutic use; D002644:Chickenpox / Q000150:complications / Q000188:drug therapy*; D002648:Child; D003082:Colectomy; D003093:Colitis, Ulcerative / Q000150:complications / Q000188:drug therapy; D003424:Crohn Disease / Q000150:complications / Q000188:drug therapy / Q000601:surgery; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D015212:Inflammatory Bowel Diseases / Q000150:complications* / Q000188:drug therapy; D007275:Injections, Intravenous; D008297:Male; D008532:Megacolon, Toxic / Q000150:complications / Q000601:surgery; D008775:Methylprednisolone / Q000009:adverse effects / Q000627:therapeutic use; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D012007:Rectum / Q000601:surgery; D012074:Remission Induction; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D002511:Cephalosporins; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D001379:Azathioprine; D002506:Cephalexin; D011241:Prednisone; D000212:Acyclovir; D008775:Methylprednisolone