CASE REPORT - Remission of RA after acute disseminated varicella-zoster infection

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Clin Rheumatol. 2006 Jan 21;:1-2 [Epub ahead of print]

Remission of rheumatoid arthritis after acute disseminated varicella-zoster

infection.

Agarwal V, Singh R, Chauhan S.

Department of Medicine, Government Medical College & Hospital, Chandigarh,

India.

A 65-year-old immunocompetent male presented with symmetric polyarthritis of

12 weeks and paresthesias in the distribution of the left median nerve

distribution of 4 weeks duration. He had tender joint count of 20 and

swollen joint count of 12. He was positive for rheumatoid factor and his

erythrocyte sedimentation rate was 52 mm. Nerve conduction study

demonstrated polyneuropathy. Radiographs showed severe juxta articular

osteopenia at the wrist and the metacarpophalangeal joints. He received

methotrexate of 10 mg/week and prednisolone of 0.15 mg/kg/day along with

nonsteroidal antiinflammatory drugs (NSAIDs) with a diagnosis of

seropositive rheumatoid arthritis (RA). Thirteen weeks after therapy, he

presented to the outpatient clinic with disseminated vesicular eruptions all

over his body with erythematous base and pneumonia involving the left upper

lobe. Tzanck smear from the lesions and serology (IgG) for varicella-virus

infection were positive. A diagnosis of acute disseminated varicella zoster

with pneumonia was made. The patient improved on parenteral acyclovir and

broad-spectrum antibiotics. With the improvement in rash and pneumonia after

2 weeks, the patient noticed a marked improvement in the joint symptoms.

Arthritis remained in remission without the need for any disease-modifying

drug or NSAID for next the 24 months and continued to be so until the last

follow-up. Our case presents a unique phenomenon of RA remission after

disseminated varicella-zoster infection in an immunocompetent individual.

PMID: 16429237

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=pubmed & dopt=Abstra\

ct & list_uids=16429237

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