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VZV on Immunosuppression — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostVZV on ImmunosuppressionSCE Infectious Diseases

A 42-year-old man with ulcerative colitis on Azathioprine develops shingles. He is started on Valaciclovir. His gastroenterologist asks whether Azathioprine should be dose-reduced during acute VZV infection. What is the advice?

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Correct answer: B — Temporary dose reduction or interruption of Azathioprine may be considered to reduce immunosuppression during acute VZV; this is a clinical judgement balancing VZV severity against UC flare risk

During acute VZV reactivation in an immunosuppressed patient, temporary reduction or interruption of immunosuppressive therapy may be considered to allow immune recovery and viral clearance. This is a clinical judgement weighing the severity of VZV infection against the risk of disease flare (UC in this case). If VZV is uncomplicated dermatomal disease, continuing Azathioprine with antiviral cover may be appropriate. If there is concern about dissemination or severe disease, temporary dose reduction is reasonable. Specialist advice should be sought.

Reference: BSR 2024 – Immunosuppression and infection; NICE CKS 2024 – Shingles in immunosuppression