SHM Converge Scientific Abstract ePoster Gallery-VZV Pneumonitis in an Immunocompromised Patient Undergoing Car-T Cell Therapy

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This case report describes a 65-year-old woman with diffuse large B-cell lymphoma who had completed CAR T-cell therapy four months earlier and later presented with one week of diffuse abdominal pain. She was initially treated for presumed sepsis from cholangitis, but her hospital course became complicated by rapidly worsening respiratory failure, widespread hemorrhagic skin lesions, encephalopathy, and seizures.<br /><br />Further evaluation revealed VZV and CMV PCR positivity, and additional history suggested questionable adherence to outpatient acyclovir prophylaxis. Broad-spectrum antibiotics were stopped, and she was treated with intravenous acyclovir for 21 days along with atovaquone for Pneumocystis jiroveci pneumonia prophylaxis because of high-dose glucocorticoid use. Imaging and EEG findings suggested atypical posterior reversible encephalopathy syndrome (PRES).<br /><br />Her condition was severe enough to require intubation, vasopressor support, and later tracheostomy after 18 days of mechanical ventilation. Although she could not be extubated immediately, her respiratory status gradually improved, she was decannulated 45 days after tracheostomy, and she eventually recovered enough to be discharged.<br /><br />The report emphasizes that CAR T-cell therapy, while an important cancer treatment that involves modifying a patient’s T cells to attack tumor cells, can produce profound immunosuppression. This places patients at high risk for serious opportunistic infections such as VZV pneumonitis, which can be fatal even with prompt antiviral therapy. The case highlights the importance of medication reconciliation, adherence to antiviral prophylaxis, early PCR testing, and multidisciplinary management in immunocompromised patients.

Asset Subtitle

Kishan G. Patel

Meta Tag

Author List Hira Sheikh, Kishan G. Patel, Robert Chanthavongsa

Category Clinical Vignettes

Concept CAR-T Therapy

Concept Cytokine Release Syndrome

Concept Varicella-Zoster Virus Pneumonitis

Concept Chimeric Antigen Receptor

Concept Immunosuppression

Distinguished Non-Finalist

Presenter Organization Nuvance Health

Presenting Author Kishan G. Patel

Track Adult

Keywords

CAR T-cell therapy

diffuse large B-cell lymphoma

varicella-zoster virus

cytomegalovirus

opportunistic infection

VZV pneumonitis

posterior reversible encephalopathy syndrome

immunosuppression

acyclovir prophylaxis

respiratory failure

CAR-T Therapy

Cytokine Release Syndrome

Varicella-Zoster Virus Pneumonitis

Chimeric Antigen Receptor

Immunosuppression