Suçiçeği ile Birlikte Başlayan Akut Demiyelinizan Ansefalomiyelitte Steroid Tedavi Çelişkisi:Bir Pediatrik Vaka Örneği
Abstract
Varicella zoster virus (VZV)’un
primer enfeksiyonu suçiçeği hastalığına neden olmaktadır ve tipik veziküler
döküntüler ile tanı konulmaktadır. Bulaşıcı bir enfeksiyon hastalığı olması
dolaysıyla okul öncesi ve okul çağı çocuklarında epidemiktir. Sağlıklı
çocuklarda enfeksiyon genellikle kendiliğinden iyileşmektedir. Postenfeksiyoz
serebellar ataksi en sık gelişen nörolojik komplikasyondur. Daha az sıklıkta
ansefalit, ansefalomiyelit, menenjit, nöbet ve demiyelinizan hastalıklar gibi
ağır komplikasyonlar da görülmektedir. Suçiçeği ile ilişkili postenfeksiyoz
demiyelinizan hastalıkların tevdisinde steroidler, intravenöz immunglobulin
(IVIG) veya plasma değişimi (PE) gibi immun modülator tedaviler
uygulanmaktadır. Ancak suçiçeği ile eş zamanlı demiyelinizan bir hastalık
geliştiğinde mevcut viral hastalığı ağırlaştırma riski dolaysıyla steroid
tedavisinin uygulanabilirliği konusunda tam bir netlik yoktur. Bu yazıda
suçiçeği döküntüsü ile eşzamanlı olarak akut demiyelinizan ansefalomiyelit
(ADEM) gelişen ve IVIG, PE ve steroid tedavilerine rağmen ağır nörolojik hasar
kalan bir pediatrik vaka sunulmuştur.
References
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- 2. Javed S, Javed SA, Tyring SK. Varicella vaccines. Curr Opin Infect Dis 2012;25:135-140.
- 3. Grimprel E, Levy C, de La Rocque F, Cohen R, Soubeyrand B, Caulin E, et al. Paediatric varicella hospitalisations in France: a nationwide survey. Clin Microbiol Infect 2007;13:546-49.
- 4. Kolski H, Ford-Jones EL, Richardson S, Petric M, Nelson S, Jamieson F, et al. Etiology of acute childhood encephalitis at The Hospital for Sick Children,Toronto, 1994-1995. Clin Infect Dis 1998;26:398-409.
- 5. Nagel MA, Forghani B, Mahalingam R, Wellish MC, Cohrs RJ, Russman AN, et al. The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy. Neurology 2007;68:1069-73.
- 6. Gilden D, Nagel M, Cohrs R, Mahalingam R, Baird N. Varicella zoster virus in the nervous system. F1000Res 2015;4.pii: F1000 Faculty Rev-1356, Last update:15 Feb 2016.
- 7. Celik Y, Tabak F, Mert A, Celik AD, Aktuglu Y. Transvers myelitis caused by varicella. Clin Neurol Neurosurg 2001;103:260-261.
- 8. Blumental S, Sabbe M, Lepage P. Varicella paediatric hospitalisations in Belgium: a 1-year national survey. Arch Dis Child 2016;101;16-22.
- 9. Tenembaum S, Chitnis T, Ness J, Hahn JS. Acute disseminated encephalomyelitis. Neurology 2007;68(16 Suppl 2):23–36.
- 10. Science M, MacGregor D, Richardson SE, Mahant S, Tran D, Bitnun A. Central nervous system complications of varicella-zoster virus. J Pediatr 2014;165:779-85.
Pitfall of Steroid Treatment in Acute Demyelinating Encephalomyelitis Coexistent with Chickenpox: A Pediatric Case Report
Abstract
Primary
infection of varicella zoster virus (VZV) causes to chickenpox and easily
diagnosed with typical vesicular rashes. It is epidemic in pre-school and
school age children since acute infection is very contagious. Infection usually
heals spontaneously in healthy children. While post-infectious cerebellar
ataxia is the most common complication of the central nervous system (CNS), it
leads less likely to encephalitis, encephalomyelitis, meningitis, seizures and
demyelinating diseases. Steroid and immune modulator treatments such as intravenous
immunoglobulin (IVIG) or plasma exchange (PE) may be administered in the
treatment of chickenpox related post-infectious demyelinating diseases.
However, there is no clear data whether steroid treatment of demyelinating
disease coexistent with chickenpox is suitable or not. In this article, we
present a pediatric patient who acute demyelinating encephalomyelitis (ADEM)
coexistent with chickenpox and given steroid treatment following IVIG and PE
treatments.
References
- 1. Gershon AA, Gherson MD. Patogenesis and current approaches to control of varicella-zoster virus infections. Clin Microbiol Rev 2013;26:728-43.
- 2. Javed S, Javed SA, Tyring SK. Varicella vaccines. Curr Opin Infect Dis 2012;25:135-140.
- 3. Grimprel E, Levy C, de La Rocque F, Cohen R, Soubeyrand B, Caulin E, et al. Paediatric varicella hospitalisations in France: a nationwide survey. Clin Microbiol Infect 2007;13:546-49.
- 4. Kolski H, Ford-Jones EL, Richardson S, Petric M, Nelson S, Jamieson F, et al. Etiology of acute childhood encephalitis at The Hospital for Sick Children,Toronto, 1994-1995. Clin Infect Dis 1998;26:398-409.
- 5. Nagel MA, Forghani B, Mahalingam R, Wellish MC, Cohrs RJ, Russman AN, et al. The value of detecting anti-VZV IgG antibody in CSF to diagnose VZV vasculopathy. Neurology 2007;68:1069-73.
- 6. Gilden D, Nagel M, Cohrs R, Mahalingam R, Baird N. Varicella zoster virus in the nervous system. F1000Res 2015;4.pii: F1000 Faculty Rev-1356, Last update:15 Feb 2016.
- 7. Celik Y, Tabak F, Mert A, Celik AD, Aktuglu Y. Transvers myelitis caused by varicella. Clin Neurol Neurosurg 2001;103:260-261.
- 8. Blumental S, Sabbe M, Lepage P. Varicella paediatric hospitalisations in Belgium: a 1-year national survey. Arch Dis Child 2016;101;16-22.
- 9. Tenembaum S, Chitnis T, Ness J, Hahn JS. Acute disseminated encephalomyelitis. Neurology 2007;68(16 Suppl 2):23–36.
- 10. Science M, MacGregor D, Richardson SE, Mahant S, Tran D, Bitnun A. Central nervous system complications of varicella-zoster virus. J Pediatr 2014;165:779-85.
Details
| Primary Language | English |
|---|---|
| Journal Section | Articles |
| Authors | |
| Publication Date | August 15, 2019 |
| Submission Date | January 7, 2019 |
| Published in Issue | Year 2019 Volume: 1 Issue: 2 |
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