Systemic varicella-zoster virus infection in two critically ill patients in an intensive care unit

Table 1 A summary of the two cases

	Case 1	Case 2
Sex	Male	Female
Age	69	75
Underlying disease	MM, bone marrow transplantation and chemotherapy	CABG, AVR, Af, DM, obesity, psoriasis vulgaris
Disease for ICU admission	Streptococcus pneumonia-induced Purpura fulminans	Severe acute pancreatitis
Complications after ICU admission	ARDS, Renal impairment, DIC, quadruple amputation, VAP	DIC, cerebral infarction
History of VZV vaccination	Unknown	Unknown
History of VZV infection	Unknown	Unknown
Recent contact with VZV	Not likely	Not apparent
Steroid use before admission	PSL, 5 mg/day	PSL, 4 mg/day
Steroid use after admission	mPSL, started with 1 mg/kg/day then tapered to PSL 5 mg/day	PSL, 4 mg/day
APACHE II score	26	20
SOFA score	10	7
Onset after ICU admission, days	71	16
Onset after intubation, days	71	16
Blood transfusion before onset	RCC, 78 units; FFP, 27 units; PC, 510 units	None
EIA-IgM (cutoff; 0.8)
one week before onset	0.24	0.22
at the time of onset	0.15	0.15
after onset	0.52 (2 weeks)	0.47 (1 week)
EIA-IgG (cutoff; 2.0)
one week before onset	13.2	8.2
at the time of onset	34.5	102.5
after onset	>128 (2 weeks after onset)	120.8 (1 week after onset)
Distribution of vesicles	Vesicles with umbilical fossa appeared diffusely and bilaterally on face, trunk, and extremities
Time to cluster forming	11 days	7 days
Treatment, dose and duration	250 mg of acyclovir every 24 h intravenously for 7 days and 5 g/day of immunoglobulin for 3 days	500 mg of acyclovir every 8 h intravenously for 7 days and vidarabine topically
Outcome	Survived	Died 14 days after the onset

Abbreviations: Af Atrial fibrillation, AKI acute kidney injury, APACHE II score Acute Physiology and Chronic Health Evaluation II score, ARDS Acute respiratory distress syndrome, AVR Aortic valve replacement, CABG Coronary artery bypass grafting, DIC Disseminated Intravascular Coagulopathy, DM Diabetes mellitus, EIA Enzyme Immunoassay, FFP Fresh frozen plasma, MM Multiple myeloma, mPSL methylprednisolone, PC Platelet concentration, PSL Prednisolone, RCC Red blood cell concentration, SOFA score Sequential Organ Failure Assessment score, VAP Ventilator-associated pneumonia, VZV varicella-zoster virus.

ISSN: 1743-422X