Successful treatment of fulminant hepatitis due to varicella zoster virus using immunoglobulin in a kidney transplant patient

Abstract

The clinical benefit of adjuvant intravenous immunoglobulin (WIG) therapy is controversial in immunocompromised patients with severe varicella. A twenty-one-year-old woman who had received a kidney transplant one year earlier presented with fever and generalized rash for 5 days. Initial immunoglobulin M (IgM) and IgG for varicella zoster virus (VZV) were negative; however, the patient was diagnosed with varicella with fulminant hepatitis because VZV-specific PCR from skin vesicles and blood was positive. The patient received intravenous acyclovir and 5-day IVIG. The decline of plasma viral load was steeper (beta coefficient-0.446) during WIG therapy than after the therapy (beta coefficient -0.123) (P= 0.04), while VZV glycoprotein IgG titers and VZV-specific T cell responses were not detected during the 5-day WIG therapy. The patient improved without any complications. This case provides an experimental evidence that adjuvant IVIG can significantly reduce viral load in immunocompromised patients with severe varicella.