Discussion:
Kidney transplantation is a therapeutic choice for end-stage renal disease. Kidney transplantation offers the patients a better quality of life as they are free from fluid and potassium restriction, better metabolic function and normal hemoglobin as normal kidney function return6. Immunosuppressants are essential for the allograft function to be successful. These medications functions by reducing the allograft rejection response and are used for maintenance, treating rejection reactions, and induction (strong immunosuppression in the early days after transplantation). However, using immunosuppressants also has drawbacks6. The body will be more vulnerable to a variety of opportunistic infections due to the body’s immune system being suppressed, which can both jeopardize the outcome of kidney transplants and result in fatalities7, 8. Up to 44.9–82% of recipients of kidney transplants get infections postoperatively, including viral infections like cytomegalovirus and varicella as well as urinary tract infections and pneumonia. The highest percentages of infections among patients who are on immunosuppressants are caused by bacteria, fungi, and viruses in 50%, 30%, and 5%, respectively; while 15% of infections are considered as polymicrobial9 . Fever, pneumonia, enteritis, meningitis, and encephalitis are some of the clinical manifestations of viral infections. As a result, the immune system is suppressed, which raises the risk of opportunistic infections10.
For the past three years, our patient has been living with a transplanted kidney and during that time there have been no complaints. He was using corticosteroids, mycophenolate mofetil, and tacrolimus as his three immunosuppressants.
Rapid diagnosis is necessary to select the appropriate antiviral therapy in immunocompromised patients at the time of acute VZV infection. Tissue culture can be used to isolate VZV; this technique is not, however, quick enough to affect therapeutic decision-making. The virological assay to identify VZV antigens using monoclonal antibodies is the quickest test. Due to a lack of resources, neither culture isolation nor any other techniques were used to diagnose this patient. The clinical signs actually showed varicella infection (chickenpox)11.
Giving an antiviral medication as soon as possible, preferably within the first 24 hours after the rash initially starts, will produce the best results. Antiviral medication can be substituted orally if clinical improvement occurs12.
Although being the high risk group for infections, Vaccinations had never been administered to our patient before. Some recommendations call for the delivery of vaccines to every patient receiving an organ transplant. Seronegative individuals should receive two doses of pre-transplant immunization, spaced four weeks apart, to help prevent serious infection. The chosen vaccine must be suitable for chronic kidney disease patients13.