PMC4978193_01
(A) A photo obtained on hospital day 5 showing a tender erythematous, vesicular, crusting lesion on the right periorbital skin. (B) An erythematous patch without a vesicular rash over the perilaryngeal skin just after intubation. (C) Axial CT of the neck demonstrating an expansive lesion in the right supraglottic region (arrow). Note that diffuse reticulation of subcutaneous fat was detected in the right cervical territory, suggesting cellulitic inflammation (arrowhead).
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A 63-year-old male patient whose condition was complicated by nephrotic syndrome presented with a five-day history of severe right periorbital edema with eruption of blisters over the ipsilateral forehead (Fig. 1A). A Tzanck smear test of the vesicular lesions revealed multinucleated giant cells, while he also complained of a sore throat associated with odynophagia and burning pain in the right cervical area with an erythematous patch (Fig. 1B). A computed tomography (CT) scan showed the presence of a supraglottic mass (Fig. 1C), while endoscopy revealed a right laryngeal space-occupying lesion involving the false vocal cord and aryepiglottic fold filling the right pyriform sinus, thereby causing almost complete airway obstruction.
The clinical course of the current patient. From the point of admission, which was designated as hospital day 1, the orally administered PSL was transiently switched to the intravenous PSL sodium succinate (PSL-SS). The resumed oral PSL was tapered thereafter and subsequently terminated. After starting the HD treatment for the deteriorated renal function as well as strict volume control, his daily urine volume gradually decreased, while his serum levels of Cr were finally settled around 8-10 mg/dL.
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We then discontinued the administration of ACV and gave priority to the simultaneous treatment of the CMV and VZV infections with intravenous ganciclovir (GCV; 1.29 mg/kg) thrice a week (Fig. 2), although this agent is not the first-line treatment for VZV-related disease.