Characteristics and repercussion of varicella-zoster virus infection in cardiac transplant.

Generally, the need for information about varicella-zoster virus (VVZ) infection in cardiac transplantation (CT) is greater than that for other organ transplants. All cases of VVZ infection among the 175 CT patients included herpes zoster as the clinical syndrome in all 11 cases (men, 90.9%; mean age, 50.3+/-5 years; incidence, 6.3%). The infection was limited to one dermatome in seven patients (63.6%: thoracic, 6%; ophthalmic, 1), or two contiguous dermatomes in four patients (36.4%). The infection onset was after the first semester in seven patients (63.6%). All patients received three drug immunosuppressive therapy. Cardiac rejection during the three previous months occurred in one patient (3A grade). Previous CMV disease was observed in three patients (27.3%: range, 7-14 months). Intravenous acyclovir was administered to five patients (ophthalmic and several dermatome forms), and oral therapy for the rest. All the patients recovered; there were no complications or postherpetic neuralgia (mean follow-up: 16.5 months). VVZ infection, a frequent late infection among CT recipients, presents as a clinical syndrome of herpes zoster, frequently in patients with previous CMV infection. In CT, herpes zoster frequently affects two dermatomes, but the clinical courses and responses to treatment are favorable. There was no postherpetic neuralgia.

Elevación del segmento ST sin lesiones coronarias significativas durante un ecocardiograma de estrés con dobutamina / St segment elevation without severe coronary stenosis during dobutamine stress echocardiography

El ecocardiograma de estrés con dobutamina (ESD) es una técnica de uso cada vez más rutinario en el diagnóstico de la enfermedad coronaria. La aparición de alteraciones en el electrocardiograma durante la prueba corresponde habitualmente a una depresión del segmento ST y en raras ocasiones a una elevación del ST, relacionándose con lesiones coronarias graves o infarto agudo de miocardio (IAM) previo. La elevación del ST, en ausencia de lesiones coronarias significativas, es muy infrecuente y se supone relacionada con un mecanismo vasoespástico. Presentamos el caso de un varón joven y con factores de riesgo cardiovascular, ingresado para estudio de dolor torácico y con ergometría negativa, que durante la prueba de dobutamina presenta positividad clínica, eléctrica en forma de ascenso del ST y alteraciones segmentarias de la contractilidad. Coronariografía sin lesiones coronarias significativas. Se comenta el caso y se revisa la literatura. (AU)