Varicella-zoster virus hepatitis in polymyositis
Fumitaka Mizoguchi1, Satsuki Nakamura, Hideyuki Iwai
1Department of Medicine and Rheumatology, Graduate School, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
Modern Rheumatology
|March 25, 2008
Summary
A patient developed severe varicella-zoster virus (VZV) hepatitis after starting methotrexate for polymyositis. Prompt treatment with acyclovir and supportive care led to recovery, highlighting VZV risks in immunosuppressed patients.
Area of Science:
- Hepatology
- Virology
- Immunology
Background:
- Polymyositis is an autoimmune inflammatory myopathy.
- Corticosteroid therapy is common but associated with side effects.
- Methotrexate is used to reduce corticosteroid dependence in autoimmune diseases.
Observation:
- A 31-year-old woman with polymyositis experienced abdominal pain, lower back pain, generalized pustulosis, severe liver dysfunction, and disseminated intravascular coagulation.
- Symptoms began 14 days after initiating low-dose methotrexate for corticosteroid tapering.
Findings:
- The patient was diagnosed with varicella-zoster virus (VZV) hepatitis.
- Treatment included acyclovir, immune globulin, and plasmapheresis.
- A favorable outcome was achieved with the initiated treatment regimen.
Implications:
- Varicella-zoster virus (VZV) infection can lead to severe hepatitis in immunosuppressed individuals.
- Physicians must consider VZV reactivation as a potential complication in patients on immunosuppressive therapy.
- Early diagnosis and prompt antiviral treatment are crucial for managing VZV hepatitis.
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