Atypical Reactivation of Varicella Zoster Virus Associated with Pancreatitis in a Heart Transplant Patient.

Authors

Christine Shieh, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
Ashley Barnes, Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, USA
Drew Johnson, Division of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
Ilya Danelich, PharmD, BCPS, BCCP, Department of Transplantation, Thomas Jefferson University, Philadelphia, PA, USA.Follow
Preethi Pirlamarla, Division of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
Rene Alvarez, Division of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA
H. Todd Massey, MD, Department of Cardiothoracic Surgery, Thomas Jefferson University, Philadelphia, PA, USA.Follow
Mahek Shah, Division of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA

Document Type

Article

Publication Date

8-12-2020

Comments

This article has been peer reviewed. It was published in: American Journal of Case Reports.

Volume 21, 2020, Article number e923969, Pages 1-4.

The published version is available at DOI: 10.12659/AJCR.923969

Copyright © Am J Case Rep, 2020

Abstract

BACKGROUND Acute pancreatitis is rare following solid organ transplantation but is associated with high mortality. It has been most commonly reported following renal transplant but can occur with other solid organ transplantations. CASE REPORT A 46-year-old male who had an orthotopic heart transplant 6 months ago presented with a 3-week history of abdominal pain. The patient described it as intermittent, sharp, and stabbing, originating in the periumbilical area and radiating to the back. His lipase was elevated at 232 U/L. Given that the patient's symptoms and lipase were elevated to greater than three times the upper limit of normal, he patient was diagnosed with acute pancreatitis. The patient also mentioned a diffuse itchy rash that started a few days prior to admission. Dermatology was consulted, and given the man's clinical presentation, there was concern for atypical reactivation of varicella zoster virus (VZV). VZV polymerase chain reaction of the vesicles returned positive. The patient was started on acyclovir and his symptoms improved. CONCLUSIONS This is the first reported case of VZV-associated pancreatitis in a heart transplant patient. Our patient presented with acute pancreatitis and was treated supportively. However, he did not receive antiviral treatment until his rash was discovered. Timely treatment of VZV resulted in resolution of both the rash and pancreatitis. Timely diagnosis of pancreatitis and VZV is important to prevent development of multiorgan failure and death.

Recommended Citation

Shieh, Christine; Barnes, Ashley; Johnson, Drew; Danelich, PharmD, BCPS, BCCP, Ilya; Pirlamarla, Preethi; Alvarez, Rene; Massey, MD, H. Todd; and Shah, Mahek, "Atypical Reactivation of Varicella Zoster Virus Associated with Pancreatitis in a Heart Transplant Patient." (2020). Division of Internal Medicine Faculty Papers & Presentations. Paper 36.
https://jdc.jefferson.edu/internalfp/36

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

PubMed ID

32785212