Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case Series
Abstract Introduction Immunocompromised patients are at increased risk for herpes zoster (HZ)-associated complications. Despite standard therapy with systemic antiviral drugs and analgesics, complications are frequently encountered, including generalization of lesions or persistent neuropathic pain,...
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| Format: | Article |
| Language: | English |
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Adis, Springer Healthcare
2023-09-01
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| Series: | Dermatology and Therapy |
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| Online Access: | https://doi.org/10.1007/s13555-023-01019-6 |
| _version_ | 1797669597332111360 |
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| author | Patrick Terheyden Cord Sunderkötter Franz-Dietmar Söhngen Linda Golle Sonja Schimo Ralf Baron Christian Maihöfner Andreas Binder Wolfram Pönisch |
| author_facet | Patrick Terheyden Cord Sunderkötter Franz-Dietmar Söhngen Linda Golle Sonja Schimo Ralf Baron Christian Maihöfner Andreas Binder Wolfram Pönisch |
| author_sort | Patrick Terheyden |
| collection | DOAJ |
| description | Abstract Introduction Immunocompromised patients are at increased risk for herpes zoster (HZ)-associated complications. Despite standard therapy with systemic antiviral drugs and analgesics, complications are frequently encountered, including generalization of lesions or persistent neuropathic pain, so-called post-herpetic neuralgia (PHN). Given the scarcity of literature and awareness of therapeutic options to improve patient outcomes, especially for vulnerable patient groups, here we describe a strategy based on early intensification of treatment with a varicella zoster virus-specific hyperimmunoglobulin (VZV-IgG), which is approved in the adjuvant treatment of HZ. Methods For this case series, we selected four cases of HZ in patients with impaired immunity due to hemato-oncologic disease or immunosuppressive treatment who presented with either existing generalized lesions and/or severe pain or with other risk factors for a complicated HZ course such as PHN. They were considered to be representative examples of different patient profiles eligible for intensification of treatment by the addition of VZV-IgG to virostatic therapy. Case Report All patients showed a rapid response to combined treatment with VZV-IgG and a virostatic agent. In two patients who had generalized lesions, the formation of new lesions ceased 1 day after VZV-IgG infusion. One patient, with mantle cell lymphoma, achieved complete healing of the lesions 9 days after diagnosis of HZ, a rare occurrence compared to similar cases or cohorts. A patient with HZ in the cervical region showed a good response after a single dose of VZV-IgG. None of the patients developed post-zoster-related complications. Combination therapy of a virostatic agent and VZV-IgG was well tolerated in these four cases. Conclusion This case series demonstrates highly satisfactory treatment effectiveness and tolerability for VZV-IgG in the adjuvant treatment of immunocompromised HZ patients and supports early intensification of HZ therapy in patients at high risk of severe disease progression. |
| first_indexed | 2024-03-11T20:46:45Z |
| format | Article |
| id | doaj.art-c67127361620416797dd3bf7c6d7e4c8 |
| institution | Directory Open Access Journal |
| issn | 2193-8210 2190-9172 |
| language | English |
| last_indexed | 2024-03-11T20:46:45Z |
| publishDate | 2023-09-01 |
| publisher | Adis, Springer Healthcare |
| record_format | Article |
| series | Dermatology and Therapy |
| spelling | doaj.art-c67127361620416797dd3bf7c6d7e4c82023-10-01T11:06:34ZengAdis, Springer HealthcareDermatology and Therapy2193-82102190-91722023-09-0113102461247110.1007/s13555-023-01019-6Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case SeriesPatrick Terheyden0Cord Sunderkötter1Franz-Dietmar Söhngen2Linda Golle3Sonja Schimo4Ralf Baron5Christian Maihöfner6Andreas Binder7Wolfram Pönisch8Department of Dermatology, University of LübeckDepartment of Dermatology and Venereology, University Hospital Halle (Saale), Martin Luther University Halle-WittenbergDepartment of Hematology and Oncology, Hospital Altenburger Land GmbHDepartment of Dermatology and Venereology, University Hospital Halle (Saale), Martin Luther University Halle-WittenbergBiotest AGDivision of Neurological Pain Research and Therapy, Department of Neurology, University Hospital Schleswig-HolsteinDepartment of Neurology, General Fürth Hospital, University of ErlangenDepartment of Neurology, Hospital Saarbrücken gGmbHHematology and Cell Therapy, Medical Clinic and Policlinic 1, University Hospital Leipzig, University of LeipzigAbstract Introduction Immunocompromised patients are at increased risk for herpes zoster (HZ)-associated complications. Despite standard therapy with systemic antiviral drugs and analgesics, complications are frequently encountered, including generalization of lesions or persistent neuropathic pain, so-called post-herpetic neuralgia (PHN). Given the scarcity of literature and awareness of therapeutic options to improve patient outcomes, especially for vulnerable patient groups, here we describe a strategy based on early intensification of treatment with a varicella zoster virus-specific hyperimmunoglobulin (VZV-IgG), which is approved in the adjuvant treatment of HZ. Methods For this case series, we selected four cases of HZ in patients with impaired immunity due to hemato-oncologic disease or immunosuppressive treatment who presented with either existing generalized lesions and/or severe pain or with other risk factors for a complicated HZ course such as PHN. They were considered to be representative examples of different patient profiles eligible for intensification of treatment by the addition of VZV-IgG to virostatic therapy. Case Report All patients showed a rapid response to combined treatment with VZV-IgG and a virostatic agent. In two patients who had generalized lesions, the formation of new lesions ceased 1 day after VZV-IgG infusion. One patient, with mantle cell lymphoma, achieved complete healing of the lesions 9 days after diagnosis of HZ, a rare occurrence compared to similar cases or cohorts. A patient with HZ in the cervical region showed a good response after a single dose of VZV-IgG. None of the patients developed post-zoster-related complications. Combination therapy of a virostatic agent and VZV-IgG was well tolerated in these four cases. Conclusion This case series demonstrates highly satisfactory treatment effectiveness and tolerability for VZV-IgG in the adjuvant treatment of immunocompromised HZ patients and supports early intensification of HZ therapy in patients at high risk of severe disease progression.https://doi.org/10.1007/s13555-023-01019-6Generalized lesionsHerpes zosterHyperimmunoglobulinImmunocompromisedVZVVaritect CP |
| spellingShingle | Patrick Terheyden Cord Sunderkötter Franz-Dietmar Söhngen Linda Golle Sonja Schimo Ralf Baron Christian Maihöfner Andreas Binder Wolfram Pönisch Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case Series Dermatology and Therapy Generalized lesions Herpes zoster Hyperimmunoglobulin Immunocompromised VZV Varitect CP |
| title | Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case Series |
| title_full | Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case Series |
| title_fullStr | Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case Series |
| title_full_unstemmed | Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case Series |
| title_short | Varicella Zoster Virus-Specific Hyperimmunoglobulin in the Adjuvant Treatment of Immunocompromised Herpes Zoster Patients: A Case Series |
| title_sort | varicella zoster virus specific hyperimmunoglobulin in the adjuvant treatment of immunocompromised herpes zoster patients a case series |
| topic | Generalized lesions Herpes zoster Hyperimmunoglobulin Immunocompromised VZV Varitect CP |
| url | https://doi.org/10.1007/s13555-023-01019-6 |
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