Reactions 1959, p23 - 3 Jun 2023 1

Aciclovir S

Lack of efficacy: case report

A 44-year-old man exhibited lack of efficacy during treatment with aciclovir for disseminated varicella zoster virus infection
[dosage not stated].
The man, who had asthma and traumatic splenectomy, admitted for persistent epigastric pain and vesicular skin rash. His home
medications included unspecified asthma inhalers and fluconazole for fungal infection. His symptoms worsened with non-bloody
vomiting and oral intolerance. The vesicular rash progressed to left ear, abdomen, back and extremities. His labs were significant for
elevated liver enzymes with negative viral hepatitis panel, HSV, and syphilis serology. HIV was found to be reactive. CT abdomen
exhibited severe edematous pancreatitis. He was treated with IV fluids and symptom control for acute pancreatitis. However, the
symptoms continued to worsen. Also, his mental status deteriorated. The rash became more diffuse. Skin shave biopsy exhibited
varicella zoster virus and positive varicella zoster virus serology. He started receiving IV aciclovir [acyclovir] and a liver biopsy was
planned. However, he suffered a cardiac arrest and died a week after the admission [immediate cause of death not stated].
Shahsavari D, et al. A Peculiar Case of Fatal Concomitant Acute Pancreatitis and Fulminant Hepatitis Due to Disseminated Varicella Zoster Infection. American Journal of
Gastroenterology 117 (Suppl. 2): S2073, No. 10, Oct 2022. Available from: URL: http://doi.org/10.14309/01.ajg.0000869644.11829.0a [abstract] 803786849

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