Longitudinal Evaluation of Serum Varicella-zoster Virus Viral Load in a Woman with Systemic Lupus Erythematosus Complicated by a Visceral Disseminated Varicella-zoster Virus Infection: A Case Report.

Visceral disseminated varicella-zoster virus infection (VD-VZV) is a rare but life-threatening condition, and treatment-response monitoring has not yet been established. We report a case of a 47-year-old woman with systemic lupus erythematosus who developed primary varicella complicated by VD-VZV during prednisolone and mycophenolate mofetil therapy. She presented with a generalized vesicular rash, dyspnea, severe epigastric pain, pneumonia, and acute hepatitis with negative VZV IgM/IgG. Intravenous acyclovir was initiated and escalated, resulting in a clinical improvement. Serum VZV DNA quantified by droplet digital PCR peaked on day 4 (3.1×106 copies/mL) and declined with recovery, suggesting that serial serum VZV DNA monitoring may be useful for assessing the disease activity and treatment response in such patients.