title: Fatal case of cutaneous-sparing orolaryngeal zoster in a renal transplant recipient.
abstract: Herpesvirus infections in solid organ transplant (SOT) recipients are a significant cause of morbidity and mortality. We report a case of herpes zoster (HZ) in a kidney transplant recipient while receiving belatacept, a CTLA-4 inhibitor that prevents acute rejection. The patient presented with oropharyngolaryngeal mucosal lesions that subsequently disseminated resulting in pneumonitis and meningo-encephalitis. Very late-onset HZ can occur and can present atypically in SOT recipients. Delayed recognition and treatment may result in poor outcomes, as illustrated by this case.
authors.affiliation: Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Elie
authors.initials: E
authors.lastname: Helou
authors.affiliation: Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Grant
authors.affiliation: Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Landry
authors.affiliation: Department of Surgical Pathology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Xinyu
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Surgical Pathology, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Jon S
authors.initials: JS
authors.lastname: Morrow
authors.affiliation: Section of Infectious Diseases, Yale University School of Medicine, New Haven, CT, USA.|Department of Surgery (Transplant), Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Maricar F
authors.initials: MF
authors.lastname: Malinis
mesh_terms: D000069594:Abatacept / Q000008:administration & dosage; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001344:Autopsy; D017809:Fatal Outcome; D005260:Female; D006562:Herpes Zoster / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000821:virology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage; D016030:Kidney Transplantation / Q000009:adverse effects*; D007819:Laryngeal Edema / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D000067562:Late Onset Disorders / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology / Q000821:virology; D008875:Middle Aged; D011241:Prednisone / Q000627:therapeutic use; D066027:Transplant Recipients
chemical_list: D000893:Anti-Inflammatory Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000069594:Abatacept; D011241:Prednisone
keywords: disseminated VZV; kidney transplant; late-onset infection