Donor organ transmission of varicella zoster due to cardiac transplantation

Background We report a case of donor-transmitted varicella tester viral (VZ V) infection in a cardiac transplant recipient. A 15-month-old girl develop ed primary VZV infection 12 days after cardiac transplantation. The donor s uffered from varicella 2 weeks before death from pneumococcal meningitis. Methods. Despite treatment of the seronegative recipient with intravenous a cyclovir from the time of surgery, she developed symptoms of fever, a nonsp ecific macular rash, and small palatal vesicles. Results. After rapid diagnostic confirmation by direct immunofluorescence o n vesicular fluid, high-dose intravenous acyclovir was commenced. In additi on, the cyclosporine dose was reduced by 25%. The child made a quick and un complicated recovery. Conclusions. Donor organ transmission of VZV has not, to our knowledge, bee n previously reported. It occurred despite treatment with acyclovir and res ulted in an atypical cutaneous eruption. It responded to an increased dose of acyclovir and a reduced level of immunosuppression.