Efficacy of plasma exchange with a high dose of acyclovir for disseminated varicella infection

  • Jun Aoyagi
  • Takahiro KanaiEmail author
  • Tomomi Maru
  • Jun Odaka
  • Takashi Saito
  • Hiroyuki Betsui
  • Takanori Yamagata
Case Report


In individuals treated with immunosuppressive therapies, the varicella-zoster virus (VZV) infection can become disseminated and lead to a life-threatening condition. There is currently no established treatment strategy for this life-threatening condition. Here, we describe a case where plasma exchange (PE) with a high dose of acyclovir (ACV) ameliorated the severe effects, including VZV-hemophagocytic lymphohistiocytosis (VZV-HLH) and disseminated intravascular coagulation (DIC), in a 9-year-old girl with steroid-dependent nephrotic syndrome. This 9-year-old girl experienced frequent relapse steroid-dependent nephrotic syndrome. She had been treated with steroids, tacrolimus, mizoribine, and rituximab. She had not previously received a varicella vaccine. She was admitted with only one vesicular rash. At admission, a serum test revealed 1.6 × 106 copies/mL of VZV DNA. The patient rapidly developed VZV-HLH and DIC. A combination of a high dose of ACV, immunoglobulin, and steroid pulse therapy could not improve these severe complications. Therefore, PE was applied. PE with a high dose of ACV successfully reduced serum VZV DNA from 7.5 × 106 to 2.8 × 104 copies/mL. This reduction in the VZV DNA copy number suggested that the combination of PE and a high dose of ACV was effective in treating a disseminated VZV infection. To the best of our knowledge, this is the first report showing that PE with a high dose of ACV ameliorated the severe complications of disseminated VZV by reducing the VZV DNA copy number.


Acyclovir Disseminated varicella infection Plasma exchange Frequent relapse steroid-dependent nephrotic syndrome Vzv-hemophagocytic lymphohistiocytosis VZV DNA copy number 


Compliance with ethical standards

Conflict of interest

The authors have declared that no conflict of interest exists.

Research involving human participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of the ethics committee of Jichi Medical University at which the studies were conducted (IRB approval number A19-009) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  • Jun Aoyagi
    • 1
  • Takahiro Kanai
    • 1
    Email author
  • Tomomi Maru
    • 1
  • Jun Odaka
    • 1
  • Takashi Saito
    • 1
  • Hiroyuki Betsui
    • 1
  • Takanori Yamagata
    • 1
  1. 1.Department of PediatricsJichi Medical UniversityTochigiJapan

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