1/10. Infections in patients with immunodeficiency with thymoma (Good syndrome). Report of 5 cases and review of the literature.Immunodeficiency with thymoma (Good syndrome, GS) is a rare, adult-onset condition that is characterized by thymoma, hypogammaglobulinemia, and low numbers of peripheral B cells. CD4 T lymphopenia and an inverted CD4:CD8 T-cell ratio may be present. Here we report 5 patients with GS and infectious complications who were seen at 3 institutions between 1983 and 1999. Three patients had recurrent sinopulmonary infections, 3 had severe cytomegalovirus (CMV) disease, and 1 had pneumocystis carinii pneumonia. review of the literature identified 46 other reports of infections in GS patients. The infections reported in all 51 patients included recurrent sinopulmonary infection (19 cases with documented respiratory pathogens), generally with encapsulated bacteria, most often haemophilus influenzae (11 cases); CMV disease (5 cases); bacteremia (7 cases); oral or esophageal candidiasis (6 cases); persistent mucocutaneous candidiasis (5 cases); chronic diarrhea (5 cases with documented stool pathogens); urinary tract infections (4 cases); P. carinii pneumonia (3 cases); tuberculosis (2 cases); Kaposi sarcoma (1 case); disseminated varicella (1 case); candidemia (1 case); wound infection with clostridium perfringens (1 case); Mycoplasma arthritis (1 case); and other infections. patients with GS present with a spectrum of sinopulmonary infections and pathogens similar to common variable immunodeficiency (CVID). Compared with patients with CVID, opportunistic infections, including severe CMV disease, P. carinii pneumonia, and mucocutaneous candidiasis, appear to be more common in patients with GS, and patients with GS may have a worse prognosis. GS should be ruled out in patients with thymoma or CVID who develop severe, especially opportunistic, infections. Treatment with intravenous immune globulin is recommended for all patients with GS.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
2/10. Disseminated herpes simplex virus and varicella zoster virus coinfection in a patient taking thalidomide for relapsed multiple myeloma.Disseminated herpes simplex virus (HSV) and varicella zoster virus (VZV) have been reported individually in immunosuppressed adults. We present a case of coinfection with disseminated HSV and VZV infection in a patient taking thalidomide for relapsed multiple myeloma. This is the first report of opportunistic infection associated with thalidomide.- - - - - - - - - - ranking = 5keywords = varicella (Clic here for more details about this article) |
3/10. Unilateral varicella zoster virus ophthalmicus and contralateral acute retinal necrosis.We report two patients who developed varicella zoster virus (VZV) ophthalmicus complicated by ipsilateral keratouveitis, and within 4 weeks developed acute retinal necrosis (ARN) in the contralateral eye. The ipsilateral retina was spared in each case. One patient had systemic lupus erythematosus (SLE) and the other Hodgkin's disease. Both patients were in remission at the time of presentation.- - - - - - - - - - ranking = 5keywords = varicella (Clic here for more details about this article) |
4/10. Disseminated ecthymatous herpes varicella-zoster virus infection in patients with acquired immunodeficiency syndrome.Herpesvirus infections are among the most common and debilitating opportunistic infections in patients with acquired immunodeficiency syndrome (AIDS), and they may have atypical clinical features. We describe the cases of three patients with AIDS in whom atypical persistent ulcerative skin lesions developed as a result of varicella-zoster virus infection. Two patients had disseminated infection without a vesicular stage; one patient had underlying asteatotic eczema. All responded well to acyclovir. One patient was treated with azidothymidine, and typical dermatomal herpes zoster subsequently developed. The profound loss of helper T cell function in AIDS may lead to multiple abnormalities in local immune response to cutaneous herpesvirus infections and may be responsible for the atypical morphology and a prolonged course.- - - - - - - - - - ranking = 5keywords = varicella (Clic here for more details about this article) |
5/10. Reinfection with varicella-zoster virus in immunocompromised patients.A small epidemic of varicella/atypical generalized zoster among 6 immunocompromised patients and one previously healthy person is described. The 6 immunocompromised patients suffered from lymphoproliferative diseases in terminal stages treated with chemotherapy and reported varicella in their childhood. They developed a generalized maculopapular rash with hemorrhagic bullae and necroses. The infection passed from one patient to another during a 3-month period in the department. They were placed in adjacent rooms and nursed by the same staff. The most specific diagnostic tool was the detection of varicella-zoster virus antigen from vesicles by ELISA technique. The epidemic was supposed to be caused by exogenous reinfection with varicella-zoster virus, and illustrated that generalized zoster may be even so infectious as varicella and that immunocompromised patients should be protected against reinfection.- - - - - - - - - - ranking = 9keywords = varicella (Clic here for more details about this article) |
6/10. Fatal varicella in steroid-dependent asthma.Disseminated varicella infection is a potentially life-threatening complication of chronic high-dose corticosteroid (CS) or immunosuppressive therapy. A review of the literature indicates that, with one possible exception, this complication has not occurred in a CS-dependent subject with asthma. We present in this article the clinical features and autopsy findings of a steroid-dependent subject with asthma who died of acute, disseminated varicella. A 16-year-old poorly compliant, steroid-dependent subject with asthma received two courses of high-dose intravenous methylprednisolone during a 3-week period, followed by a tapering schedule of oral prednisone. During this time, she was exposed to chickenpox. She subsequently developed a classic varicella rash, sever back pain, rapidly progressive hepatic failure, pneumonitis, and encephalopathy. death ensued 3 days after the onset of the rash. Evidence of disseminated varicella infection was confirmed at autopsy. This case illustrates that a small number of subjects with severe asthma receiving high-dose CS need to be considered as a separate, high-risk group for developing disseminated varicella. We recommend that the immune status of these patients to varicella-zoster virus be assessed by a serum titer. If these patients are nonimmune, they would be candidates for varicella-zoster immune globulin on exposure, and for acyclovir therapy should varicella dissemination occur.- - - - - - - - - - ranking = 12keywords = varicella (Clic here for more details about this article) |
7/10. Complications of varicella pneumonia in adults.Varicella is predominantly a disease of children, in whom it typically has a benign course and outcome. However, when the disease affects adults, the complications can be life-threatening. Varicella pneumonia, secondary bacterial infection, and opportunistic infection in the immunocompromised host are the most common complications in the adult. Surveillance for these complications is mandatory because appropriate therapy may be life-saving. The introduction of specific antiviral agents may be useful in certain clinical circumstances. The authors describe two representative patients and discuss the diagnosis and treatment. They also discuss this infection in adulthood in general.- - - - - - - - - - ranking = 4keywords = varicella (Clic here for more details about this article) |
8/10. Human herpesvirus-6-associated exanthema in a patient with acute lymphocytic leukaemia.Summary: We report the first case of human herpesvirus-6 (HHV-6) associated exanthema in a patient with acute lymphocytic leukaemia (ALL). We analysed dna extracted from an exanthematous lesion using the polymerase chain reaction (PCR). dna was positive for HHV-6 but negative for herpes simplex virus, varicella zoster virus, and cytomegalovirus. Immunohistochemical staining of the skin with monoclonal antibody against (HHV-6 confirmed the infection. The possibility of HHV-6 infection should be considered when an atypical skin rash is seen in patients with ALL.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
9/10. CMV-induced anti-Sia-b1 cold agglutinin in an immunocompromised patient.In postinfection cold agglutination, certain cold agglutinin (CA) specificities are associated with distinct infectious agents. The combined occurrence of anti-I and anti-Sia-b1 CAs following mycoplasma pneumoniae infection has been reported recently. After renal transplantation and hyperacute graft rejection, transiently occurring CAs were observed in an 18-year-old boy. The CAs were characterized by serum cold absorption with sialidase-treated red cells and warm elution from the cells. An anti-Sia-b1 CA could be differentiated from an accompanying low-liter anti-I. Fresh infections with mycoplasma pneumoniae, Epstein-Barr virus, rubella, and varicella viruses were excluded, but CMV infection was demonstrated. This is the first case of a postinfection anti-Sia-b1 CA associated with CMV infection.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
10/10. Necrotizing fasciitis complicating disseminated cutaneous herpes zoster.The association of necrotizing fasciitis, often due to group A streptococcus and primary varicella (chicken pox), is unusual but recognized in children. The association in adults is rare but one report in the literature describes a previously healthy man with the two disorders. We now describe a case of disseminated cutaneous herpes zoster complicated by subacute necrotizing fasciitis in an elderly woman taking low dose methotrexate and prednisone for rheumatoid arthritis. staphylococcus aureus was isolated. Localized debridement and split skin grafting were required.- - - - - - - - - - ranking = 1keywords = varicella (Clic here for more details about this article) |
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