title: Complete remission of VZV reactivation treated with valganciclovir in a patient with total lymphocyte depletion and acute kidney injury after allogeneic bone marrow transplantation.
abstract: Varicella zoster virus (VZV), a threat for hematopoietic stem cell transplantation (HSCT) recipients, is still one of the most common viral pathogens that affect these patients with a reported incidence ranging between 17% and 50% in the post transplantation period. Valganciclovir (V-GCV), a valine ester pro-drug of GCV orally administrable, has recently shown great activity against CMV infections, but there are no reports of its clinical efficacy against VZV. We here report a case history of a patient with positive serologic test for VZV, who underwent allogeneic HSCT and developed an atypical varicella-like illness. First-line therapy with foscarnet had to be discontinued due rapid development of renal impairment (creatinine: 2.60 mg/dL, urea: 130.6 mg/dL) and therefore was switched to V-GCV. The renal impairment and skin lesions of the patient fully recovered after few days of therapy, even though the patient had complete lymphocyte depletion. This is the first case of a patient with chickenpox-like illness treated successfully with V-GCV.
authors.affiliation: Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy.
authors.forename: Natalia
authors.initials: N
authors.lastname: Maximova
authors.forename: Pizzol
authors.initials: P
authors.lastname: Antonio
authors.forename: Granzotto
authors.initials: G
authors.lastname: Marilena
authors.forename: Francesca
authors.initials: F
authors.lastname: Rovere
authors.forename: Paolo
authors.initials: P
authors.lastname: Tamaro
mesh_terms: D058186:Acute Kidney Injury / Q000139:chemically induced*; D000293:Adolescent; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D017809:Fatal Outcome; D005260:Female; D015774:Ganciclovir / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006562:Herpes Zoster / Q000188:drug therapy*; D014645:Herpesvirus 3, Human / Q000254:growth & development*; D006801:Humans; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy*; D000077562:Valganciclovir; D019562:Viral Load
chemical_list: D000077562:Valganciclovir; D015774:Ganciclovir
keywords: HSCT; VZV; lymphocyte depletion; valganciclovir