Akademik Veri Yönetim Sistemi
24th International Intensive Care Symposium, İstanbul, Türkiye, 5 - 06 Mayıs 2023, cilt.21, sa.1, ss.87, (Tam Metin Bildiri)
[OP-113] VZV Infection in Intensive Care Unit Ayla Esin İstanbul University-Cerrahpaşa, İstanbul, Turkey Introduction: We know as VZV causes localized infection. Infections such as encephalitis, pneumonia and myocarditis can be seen in immunosuppressed patients. We aimed to present 2 nonimmunosuppressive cases with systemic VZV infection. Cases: Case 1: VZV Myocarditis A 35-year-old patient applied to hospital with fever, rash, chest pain. Vesicular rash was observed on upper extremities, chest wall, VZV was considered, valacyclovir was started. VZV was found to be IgG positive, IgM negative. Echocardiogram was within normal limits and TnI was high. She stayed in ICU for 24 hours. After the absence of chest pain and enzymes decreased, discharged with antiviral treatment. Case 2: VZV Encephalitis A 84-year-old patient, oriented, was presented to hospital due to inability to walk, impaired oral intake. She was followed up in ward for 2 days. No pathology was detected in MRI. Upon detection of AF, warfarin was started, discharged. A week later due to poor general condition, she was presented to hospital. Urinary tract infection was detected, she was admitted to ward, antibiotherapy was started. The patient with hypoxia and hypercarbia was admitted to ICU with aspiration pneumonia, intubated. Electroencephalography was performed when perioral contractions were observed; epileptiform waves were in the right frontotemporal, levetiracetam was started. The hyperemic lesions spreading in the tracing of the mandibular branch of the trigeminal nerve became vesicular, CSF sampling was performed, Acyclovir was started. Two days later, MRI was within normal limits. VZV PCR was positive. She underwent tracheostomy, taken to the ward on 26th day with ventilator support, and discharged on 43rd day alert and able to follow simple commands. Discussion: We detected VZV infection with rash in 2 of our nonimmunosuppressive patients. VZV infection, which is associated with high mortality and morbidity in adults, should be considered when vesicular rash is seen and should be treated when supported by laboratory. Keywords: VZV infection, myocarditis, encephalitis Table 1. 17.04.2019 18.04.2019 19.04.2019 20.04.2019 TnI (risc: 0.02-0.3) 0.24 0.1 0.076 0.028 ProBNP (n<125) 844 499 437 336 WBC 5470 (lenf 38%) 5490 (lenf 56%) 6250 (lenf 64%) 7130 (lenf 63%) Table 2. Myocarditis Encephalitis Age 35 84 Gender F F Co-morbidity - Parkinson, hypertension, COPD, coronary artery disease, AF Apache II 4 24 SOFA 1 6 Immunosupression - - Treatment Valacyclovir Acyclovir VZV IgG 0.89 (border) - VZV IgM 0.3 - CSF - Prot: 32.4 Glu: 83.7 RBC: 60 WBC<5 Menengitis/encephalitis PCR - VZV positive