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VZV Immunosuppression Reduction — SCE Infectious Diseases MCQ

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ModerateImmunocompromised HostVZV Immunosuppression ReductionSCE Infectious Diseases

A 40-year-old woman with SLE on Mycophenolate and Prednisolone 15 mg develops a painful vesicular rash in the T6 dermatome with new vesicles still appearing. She has no other complications. Should Mycophenolate be temporarily reduced?

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Correct answer: E — Consider temporary dose reduction of Mycophenolate during acute VZV

Active VZV reactivation in an immunosuppressed patient prompts consideration of temporary immunosuppression reduction. Mycophenolate inhibits T-cell and B-cell proliferation — reducing it may help the immune system control VZV replication. However, this must be balanced against the risk of SLE flare. Antiviral treatment (Valaciclovir 1 g TDS or Aciclovir 800 mg 5 times daily for 7–10 days) should be given at full immunocompromised dosing. The decision to reduce immunosuppression should involve the rheumatology team.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections