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Pt Info | PMH | Symptoms | Treatment | Diagnosis | Liver Biopsy |
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49 y/o M | ETOH and tobacco abuse, 15 days post radical dissection neck and laryngectomy for SCC larynx | Abdominal pain, fever, restlessness | “Intensive supportive care” | Post mortem via liver analysis | Post mortem: liver VZV DNA +, hepatic necrosis with intranuclear inclusion bodies |
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47 y/o Japanese M | MM s/p chemo, steroids, 2 stem cell transplants, moderate GVHD and relapse of MM with more chemo and steroids | Generalized fatigue | FFP, platelets | Retrospective VZV PCR + blood and liver analysis | Autopsy: + anti-VZV IgG stain of liver with hepatic necrosis seen |
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49 y/o M | No PMH except treatment for pharyngotonsillitis 15 days prior with abx and prednisone | Acute retrosternal pain | IV acyclovir, VZV immune globulin, total hepatectomy | Skin cytology c/w herpes family virus & immuno-cytochemistry stain VZV +; blood VZV DNA + | Liver bx: necrosis only; Post mortem liver VZV DNA +
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15 y/o M | None | Fever, abdominal pain, myalgia, skin vesicles | IV acyclovir, MARs
| Post mortem liver analysis | Post mortem liver analysis: hepatic necrosis, multinucleation and intranuclear inclusions of Cowdry A bodies; liver VZV PCR + |
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26 y/o CF | Diagnosed with MS 3 months prior and treated with steroids | Abd pain and vomiting | PO acyclovir → IV acyclovir | Blood and urine VZV PCR +; post mortem liver analysis
| Post mortem liver: hemorrhagic necrosis and VZV PCR + |
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64 y/o CF
| 14 months post-op esophago-gastrectomy & splenectomy | Fever, malaise, HA | Vit K | VZV titers D4: 1-64 → D7: 1-256; liver autopsy analysis | Autopsy liver: hemorrhagic necrosis and signs herpes family virus including Cowdry A intranuclear bodies; EM: intracellular virions consistent with herpes family virus |
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