Age: 1.0
Sex: F
Vaccine: MMR
Symptoms: CD4 lymphocytes decreased, Genital lesion, Herpes zoster disseminated, Immunodeficiency, Liver transplant
Clinical narrative: chickenpox; herpes zoster/multidermatomal zoster; Immunodeficiency; early cellular rejection of graft; post-transplant lymphoproliferative disorder; primary varicella; autoimmune hepatitis; liver transplant; This spontaneous report was received from a physician and refers to a 15-year-old female. The patient's medical history, concurrent conditions and concomitant therapies were not reported. The patient was enrolled in Program to identify if VZV is present and if it is present, to identify if it is associated with the wild-type (WT) VZV strain or with the Oka/Merck vaccine strain.  On 18-DEC-2007, the patient was vaccinated with unspecified varicella-zoster virus (VZV)-containing vaccine, 1 dosage form, administered for prophylaxis (strength, lot #, expiry date, and route of administration were not provided).  On an unknown date, her plasma VZV PCR was positive, with CT = 28.0 and her lesion VZV PCR was positive with CT = 17.2 (varicella zoster virus test positive).On an unknown date, the patient had performed liver transplant for an unknown reason.On an unknown date, she experienced skin lesions/rash, chickenpox, herpes zoster disseminated and immunodeficiency.The outcome of the aforementioned events was unknown.  Upon internal review, the events of liver transplant, chickenpox, herpes zoster disseminated, and immunodeficiency were considered to be medically significant.  This case is non-valid due to unspecified suspect product (class of product).  Follow-up information has been received from physician on 02-SEP-2022. Concurrent medications included tacrolimus, mycophenolate mofetil (MMF) and acyclovir sodium. On an unspecified date in 2008, was the patient's post-liver transplant (liver transplant). It was reported that disseminated varicella number of lesions are too numerous to count and distributed on face, genitalia, thoracolumbar and thighs. Herpes zoster lesions in dermatome, face and genitalia. Also, at the time of reporting the patient has not recovered from disseminated varicella and herpes zoster. On 30-AUG-2022, blood and vesicle/lesion sample was collected.  This case is non-valid due to unspecified suspect product (class of product).   Follow up information was received from two physicians on 09-SEP-2022 and 12-SEP-2022. PCR testing information as follows: Specimen collection date: 30-AUG-2022. Source of specimen: vesicle/lesion and plasm. The patient was not on an oral antivirals (e.g., acyclovir, famciclovir or valacylovir) prior to specimen collections. and dates of treatment if reported. Date specimens arrived in laboratory on 02-SEP-2022. VZV DNA was amplified, the VZV strain identification showed: wild type. Final PCR Results: wild-type strain. Both the lesion and plasma samples were VZV positive wild-type strain. The patient was exposed to the naturally circulating wild type virus. There was no known exposure to VZV and the patient did not have any antibodies to VZV despite receiving one dose of an unspecified VZV-containing vaccine as a child. The physician provided the following additional case information: On an unknown date in 2007, the patient was vaccinated with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II) subcutaneous injection, administered for prophylaxis (strength, lot #, expiry date, and route of administration were not provided) and one dose of an unspecified VZV-containing vaccine back when she was approximately 12 months old while she lived in her country. The child's medical history included a liver transplant on an unspecified date with early cellular rejection of graft. While on rituximab, she had post-transplant lymphoproliferative disorder one year post transplant. In 2018, the patient had autoimmune hepatitis but had recovered. There have been no recent episodes of graft rejection. The patient initially presented with a herpes-zoster-like "trigeminal distribution including other dermatomes" but it transitioned to a "more diffuse distribution" and was determined to be "primary varicella". The patient was treated with 9 days of IV acyclovir and was then discharged on oral acyclovir. It was determined that her CD4 and B cell responses were decreased but her lesions were crusting over, and she was otherwise doing well clinically. The treatment team was considering having her continue with oral acyclovir for an additional month for prophylaxis. The outcome of the rest events was unknown. The causal relationship between the events and suspect vaccines was not provided. Upon internal review, the events early cellular rejection of graft, post-transplant lymphoproliferative disorder and autoimmune hepatitis were determined to be medically significant.  This case become valid due to specified product.