Case Report
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 26, 2021; 9(30): 9168-9173
Published online Oct 26, 2021. doi: 10.12998/wjcc.v9.i30.9168
Fatal visceral disseminated varicella-zoster virus infection in a renal transplant recipient: A case report
Di Wang, Jin-Quan Wang, Xiao-Gen Tao
Di Wang, Jin-Quan Wang, Xiao-Gen Tao, Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230036, Anhui Province, China
Author contributions: Wang D treated the patient, collected data, wrote the paper, and approved the final manuscript; Tao XG treated the patient, revised the paper, and approved the final manuscript; Wang JQ performed the systematic literature review, reviewed the paper, and approved the final manuscript.
Informed consent statement: Written informed consent was obtained from the patient’s father for the publication of this case report.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Gen Tao, DPhil, Chief Doctor, Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, No. 17 Lujiang Road, Hefei 230036, Anhui Province, China. txg0724@163.com
Received: April 20, 2021
Peer-review started: April 20, 2021
First decision: July 15, 2021
Revised: July 16, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 26, 2021
Processing time: 184 Days and 1.5 Hours
Abstract
BACKGROUND

Visceral disseminated varicella-zoster virus (VZV) infection is a rare but life-threatening disease. In transplant recipients with VZV infection, visceral dissemination may develop without skin eruptions, which leads to the failure of early diagnosis.

CASE SUMMARY

The patient was a 33-year-old male renal recipient who was referred to our hospital with severe upper abdominal pain of 3-d duration. On admission, the patient rapidly developed septic shock and multiple organ dysfunction syndrome with liver dysfunction and acute kidney injury. Next-generation sequencing of peripheral blood yielded 39224 sequence reads of VZV, and real-time polymerase chain reaction for VZV was positive, with 1.2 × 107 copies/mL. The final diagnosis was visceral disseminated VZV infection. Acyclovir and supportive therapy were started, but the patient died of severe visceral organ damage 16 h after admission.

CONCLUSION

Visceral disseminated VZV infection is possible in renal transplant recipients presenting abdominal pain and rapidly-evolving organ damage without skin involvement.

Keywords: Septic shock; Visceral disseminated infection; Renal transplantation; Next-generation sequencing; Multiple organ failure; Case report

Core Tip: In transplant recipients, visceral disseminated varicella-zoster virus (VZV) infection may develop without skin eruptions, which leads to the failure of early diagnosis and fatal outcome. Early diagnosis and prompt antiviral therapy is the key to successful treatment. Next-generation sequencing is a promising tool for early detection of VZV infection in kidney transplant patients, even if VZV infection is not suspected.