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Savita Pahwa, MD; Karen Biron, PhD; Wilma Lim, MD; Paul Swenson, MD; Mark H. Kaplan, MD; Neil Sadick, MD; Rajendra Pahwa, MD

JAMA. 1988;260(19):2879-2882.

Abstract
Acyclovir has become the treatment of choice for varicella-zoster virus (VZV) infections in immunocompromised individuals. This article describes a 4-year-old girl congenitally infected with human immunodeficiency virus who developed a continuous cutaneous infection with VZV that persisted over a 14-month period until her death. Initial episodes of varicella and zoster were responsive to acyclovir treatment; however, subsequent recurrences necessitated administration of multiple courses of acyclovir. Lesions became markedly hyperkeratotic, slow healing, and persistent despite acyclovir therapy. Numerous attempts to isolate virus from the lesions yielded only one isolate late in the course of therapy. This virus clearly demonstrated acyclovir resistance in vitro. Bizarre manifestations of VZV infection could present both diagnostic and therapeutic dilemmas. Prolonged acyclovir treatment of highly immunocompromised patients with acquired immunodeficiency syndrome and severe VZV may lead to the appearance of resistant virus.

(JAMA 1988;260:2879-2882)

Author Affiliations
From the Departments of Pediatrics (Drs S. Pahwa, Lim, and R. Pahwa) and Medicine (Drs Swenson, Kaplan, and Sadick), North Shore University Hospital, Cornell University Medical College, Manhasset, NY; and the Department of Virology, Burroughs Wellcome Co, Research Triangle Park, NC (Dr Biron). Dr Swenson is now with Seattle—Kings County Health Department, Seattle, and Dr R. Pahwa is now with Schneider Children's Hospital, New York.

Footnotes
Presented in part at the 43rd Annual Meeting of the American Academy of Allergy and Immunology, Washington, DC, Feb 24, 1987.

Reprint requests to the Department of Pediatrics, North Shore University Hospital, 300 Community Dr, Manhasset, NY 11030 (Dr S. Pahwa).

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