title: Varicella zoster meningitis complicating combined anti-tumor necrosis factor and corticosteroid therapy in Crohn's disease.
abstract: Opportunistic viral infections are a well-recognized complication of anti-tumor necrosis factor (TNF) therapy for inflammatory bowel disease (IBD). Cases of severe or atypical varicella zoster virus infection, both primary and latent reactivation, have been described in association with immunosuppression of Crohn's disease (CD) patients. However, central nervous system varicella zoster virus infections have been rarely described, and there are no previous reports of varicella zoster virus meningitis associated with anti-TNF therapy among the CD population. Here, we present the case of a 40-year-old male with severe ileocecal-CD who developed a reactivation of dermatomal herpes zoster after treatment with prednisone and adalimumab. The reactivation presented as debilitating varicella zoster virus meningitis, which was not completely resolved despite aggressive antiviral therapy with prolonged intravenous acyclovir and subsequent oral valacyclovir. This is the first reported case of opportunistic central nervous system varicella zoster infection complicating anti-TNF therapy in the CD population. This paper also reviews the literature on varicella zoster virus infections of immunosuppressed IBD patients and the importance of vaccination prior to initiation of anti-TNF therapy.
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, AL T6G 2X8, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Ma
authors.forename: Brennan
authors.initials: B
authors.lastname: Walters
authors.forename: Richard N
authors.initials: RN
authors.lastname: Fedorak
mesh_terms: D000212:Acyclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D000068879:Adalimumab; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects; D000998:Antiviral Agents / Q000627:therapeutic use; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000276:immunology; D006562:Herpes Zoster / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D014645:Herpesvirus 3, Human / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects*; D008297:Male; D008587:Meningitis, Viral / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D011241:Prednisone / Q000009:adverse effects; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*; D000077483:Valacyclovir; D014633:Valine / Q000031:analogs & derivatives / Q000627:therapeutic use; D014775:Virus Activation / Q000187:drug effects
chemical_list: D000305:Adrenal Cortex Hormones; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha; D000068879:Adalimumab; D014633:Valine; D000077483:Valacyclovir; D011241:Prednisone; D000212:Acyclovir
keywords: Adalimumab; Anti-tumor necrosis factor; Crohn’s disease; Infliximab; Meningitis; Varicella zoster virus; corticosteroids