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Disseminated VZV — SCE Infectious Diseases MCQ

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HardImmunocompromised HostDisseminated VZVSCE Infectious Diseases

A rituximab-treated patient has fever, hepatitis and vesicles across several non-contiguous dermatomes; VZV PCR is positive and renal function is normal. Which antiviral is first line?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Intravenous aciclovir 10 mg/kg every 8 hours with hydration and clinical review for step-down

The best answer is “Intravenous aciclovir 10 mg/kg every 8 hours with hydration and clinical review for step-down”. Rituximab exposure, hepatitis and non-contiguous dermatomal lesions indicate disseminated, visceral-risk VZV. First-line treatment is intravenous aciclovir 10 mg/kg every 8 hours with hydration and review for oral step-down. Oral valaciclovir or famciclovir is for uncomplicated localised disease; foscarnet is reserved for resistance or intolerance.

Reference: Aciclovir IV SmPC: https://www.medicines.org.uk/emc/product/377/smpc