Concurrent Reactivation of Varicella Zoster Virus and Herpes Simplex Virus with Hepatic Microabscesses after Anifrolumab Treatment in Systemic Lupus Erythematosus Patient - A Case Report.
DOI:
https://doi.org/10.70672/xbea6j35Keywords:
systemic lupus erythematosus, anifrolumab, herpes zoster, herpes simplex, hepatic microabscessAbstract
This report describes a patient with long-standing, refractory systemic lupus erythematosus (SLE) who developed concurrent varicella zoster virus (VZV) and herpes simplex virus (HSV) reactivation following treatment with anifrolumab. Diagnosed with SLE at 18 years of age, she experienced multiple haematological flares and major organ involvement despite prolonged immunosuppressive therapy, including mycophenolate mofetil, cyclophosphamide, and rituximab. Ongoing disease activity led to initiation of intravenous anifrolumab. Six days after the third infusion, she presented with painful vesicular lesions involving the extremities and genital region, systemic inflammatory features, and gastrointestinal symptoms. Investigations confirmed simultaneous VZV and HSV infection, supported by positive serology and Tzanck smear findings, along with hepatic microabscesses on imaging. She was successfully treated with intravenous acyclovir, broad-spectrum antimicrobials, and intravenous immunoglobulin, with complete clinical and radiological resolution. This case highlights the risk of severe and atypical herpesvirus reactivation in heavily immunosuppressed SLE patients receiving anifrolumab and underscores the importance of early recognition and prompt antiviral therapy.
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