title: Successful rescue of disseminated varicella infection with multiple organ failure in a pediatric living donor liver transplant recipient: a case report and literature review.
abstract: A 12-year-old female patient with biliary atresia underwent living donor liver transplantation (LDLT). Twelve months after the LDLT, she developed acute hepatitis (alanine aminotransferase 584 IU/L) and was diagnosed with disseminated varicella-zoster virus (VZV) infection with high level of serum VZV-DNA (1.5 × 10(5) copies/mL) and generalized vesicular rash. She had received the VZV vaccination when she was 5-years-old and had not been exposed to chicken pox before the LDLT, and her serum was positive for VZV immunoglobulin G at the time of the LDLT. Although she underwent treatment with intravenous acyclovir, intravenous immunoglobulin, and withdrawal of immunosuppressants, her symptoms worsened and were accompanied by disseminated intravascular coagulation, pneumonia, and encephalitis. These complications required treatment in the intensive care unit for 16 days. Five weeks later, her clinical findings improved, although her VZV-DNA levels remained high (8.5 × 10(3)copies/mL). Oral acyclovir was added for 2 weeks, and she was eventually discharged from our hospital on day 86 after admission; she has not experienced a recurrence. In conclusion, although disseminated VZV infection with multiple organ failure after pediatric LDLT is a life-threatening disease, it can be cured via an early diagnosis and intensive treatment.
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. yn708@jichi.ac.jp.
authors.forename: Naoya
authors.initials: N
authors.lastname: Yamada
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. yuki371@jichi.ac.jp.
authors.forename: Yukihiro
authors.initials: Y
authors.lastname: Sanada
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. r0906no@jichi.ac.jp.
authors.forename: Noriki
authors.initials: N
authors.lastname: Okada
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. wakiya@jichi.ac.jp.
authors.forename: Taiichi
authors.initials: T
authors.lastname: Wakiya
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. ihara@jichi.ac.jp.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ihara
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. turahashi@jichi.ac.jp.
authors.forename: Taizen
authors.initials: T
authors.lastname: Urahashi
authors.affiliation: Department of Transplant Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan. koimizu@jichi.ac.jp.
authors.forename: Koichi
authors.initials: K
authors.lastname: Mizuta
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood; D002644:Chickenpox / Q000150:complications* / Q000628:therapy*; D002648:Child; D004279:DNA, Viral / Q000097:blood; D005076:Exanthema; D005260:Female; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D016867:Immunocompromised Host; D007074:Immunoglobulin G / Q000097:blood; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D016031:Liver Transplantation; D019520:Living Donors; D009102:Multiple Organ Failure; D066027:Transplant Recipients; D016896:Treatment Outcome; D019562:Viral Load
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G; D016756:Immunoglobulins, Intravenous; D000212:Acyclovir