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An immunocompromised host is one that presents an alteration in its cellular immunity as humoral or in the capacity of phagocytosis that carries a high risk of suffering an infectious complication, patients may present alterations in the mucocutaneous natural barriers allowing the passage of microorganisms and generating local and systemic infections. Immunity defects favor viral infections. Herpetic infection in the immunocompromised patient acquires a more severe clinical form such as severe chickenpox.
A 21-year-old female patient who received a related live donor transplant on April 27, 2023, who consulted in June of this year for pain and burning sensation in the left lower limb, which increased in intensity and made it difficult for her to walk, then begins with pruritus at 2 days note lesions in the left lower limb, which are skin lesions, pruritic, with vesicles, and with exanthema, which are initially limited to the front of the leg and then spread rapidly, physical examination when evaluating them include dermatoma in left lower limb and reason why patient consulted the hospital, patient laboratories at that time with laboratories with WBC 8.89, lymphocytes in 30%, neutrophils 62%, hemoglobin 11.56, hematocrit 36.7 and platelets 266,000, creatinine in 1.26, electrolytes within normal ranges, urine examination and normal urine cultures.
Approximately 90% of transplant recipients are seropositive for chickenpox zoster, as in the general population primary infection usually produced by direct exposure through skin lesions or by respiratory route triggers infection. It is usually a reactivation, patients who acquire the primary infection during the first year have the greatest risk to suffer a disseminated chickenpox, other complications include the risk of disseminated vascular coagulation and aggregate infections. In the case of our patient we consider viral herpes infection due to characteristics of the lesions, considering that it is highly prevalent in solid organ receptors with immunosuppression, and that at the patient’s re-evaluation it began with neuropathy, Case consultation to the Department of Dermatology who confirm diagnosis of herpes so it was started with treatment with Aciclovir with which clinical picture remitted.
The development of a complicated evolution is more frequent in immunocompromised patients and this determines their greater morbidity, compared to the competent patient, in addition the excess of immunosuppression in these patients favors the appearance of opportunistic genes such as viruses therefore it is important to recognize and suspect these pathologies in post-transplant renal patients for the proper treatment and avoid complications to long term among which we also consider neuropathy