acyclovir / Generic mfg. - LARVOL DELTA

A Viral Twist to a Familiar Flare: HSV Colitis in Inflammatory Bowel Disease (ACG 2025) - "Histopathology demonstrated moderate chronic active colitis with HSV viral cytopathic effect confirmed via immunohistochemical staining.Given the HSV colitis diagnosis, IV acyclovir was initiated, and IV corticosteroids were transitioned to oral prednisone...On follow-up, patient continued to do well and was ultimately restarted on vedolizumab and continued suppressive valacyclovir with colonoscopy after 6 months revealing Mayo 0 colon and resolution of HSV changes. HSV colitis can be indistinguishable in patients with UC, as it can mimic UC flare symptoms, often requiring endoscopic and histologic confirmation...Withholding immunosuppressives carries the risk of worsening UC, while continued steroids may promote viral dissemination and potential tissue necrosis. This case underscores the importance of considering rare infectious triggers of UC in patients with refractory colitis symptoms.Figure: Ulceration of sigmoid colonFigure: Punched out lesions"

Gastroenterology • Gastrointestinal Disorder • Herpes Simplex • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Mucositis • Ulcerative Colitis

A Case of Extramedullary Plasmacytoma Involving the Pancreas (ACG 2025) - "The patient began systemic treatment with daratumumab, lenalidomide, aspirin, acyclovir, and dexamethasone. Extramedullary plasmacytoma (EMP) of the pancreas is rare and often appears similar to pancreatic adenocarcinoma, typically causing jaundice and abdominal pain. Early and accurate diagnosis can lead to more effective treatment, reducing unnecessary surgeries and significantly improving outcomes.Figure: Pancreatic biopsy shows predominant population of atypical plasma cells that are CD138 positive: Hematoxylin and Eosin staining, magnification x 40 and x100. Figure: Immunostain CD138 Highlighting Plasma Cells, magnification x40"

Clinical • Anemia • Cardiovascular • Dyslipidemia • Endocrine Disorders • Gastrointestinal Disorder • Hematological Disorders • Hematological Malignancies • Hepatology • Hypertension • Melanoma • Multiple Myeloma • Pancreatic Adenocarcinoma • Pancreatic Cancer • Plasmacytoma • Solid Tumor • CD38 • SDC1

Refractory "status dyskineticus" in a child with post-herpes simplex virus 1 N-methyl-D-aspartate receptor encephalitis: a case report. (PubMed, BMC Neurol) - "This case underscores the crucial role of neurocritical care in managing refractory movement disorders associated with autoimmune encephalitis. Early recognition and immunotherapy escalation are essential to improve outcomes in children with complex, life-threatening neurological conditions. A comprehensive, multidisciplinary approach in the neurocritical care setting is key to achieving recovery and minimizing long-term neurological damage."

Journal • CNS Disorders • Critical care • Dystonia • Herpes Simplex • Immunology • Movement Disorders • Pediatrics

Practical Oral Care for HSCT (ICBMT 2025) - "Early HSV -PCR testing and intravenous acyclovir are recommended; dose escalation may be considered in cases of poor respo nse or suspected resistance...As oral pain and bleeding in HSCT patients are often closely associated with infection, appropriate oral assessment and timely interven tion are essential. Continued multidisciplinary communication and research are strongly encouraged."

Bone Marrow Transplantation • Candidiasis • Dental Disorders • Graft versus Host Disease • Hematological Disorders • Herpes Simplex • Immunology • Infectious Disease • Septic Shock • Thrombocytopenia • Xerostomia

Infection Prophylaxis in CAR T-Cell Therapy (ICBMT 2025) - "NCCN and ASTCT guidelines support the use of acyclovir 400 mg PO twice daily or valacyclovir 500 mg PO twice daily for at least six months after CAR T infusion and until CD4 T -cell counts exceed 200/µL. Hepatitis B virus (HBV) management should include entecavir or tenofovir for at least 12 months in HBsAg -positive patients and longer if immunosuppression persists; anti -HBc–positive/HBsAg -negative patients may receive prophylaxis or undergo monthly HBV DNA monitoring...Alternatives include atovaquone 1500 mg daily, dapsone 100 mg daily (after G6PD testing), or monthly aerosolized pe ntamidine for those with sulfa allergy or intolerance. Fungal Fluconazole is recommended during periods of neutropenia until neutrophil recovery. High -risk patients — those with pre -infusion neutropenia, prior invasive fungal infection within six months, prior allo -HCT, grade ≥3 CRS/ICANS, or prolonged high -dose cortic osteroids (>72 h) —should receive mould -active..."

CAR T-Cell Therapy • Hematological Malignancies • Hepatitis B • Hepatology • Herpes Zoster • Immunology • Infectious Disease • Influenza • Meningococcal Infections • Neutropenia • Pertussis • Pneumococcal Infections • Pneumonia • Respiratory Diseases • Tetanus • CD4

Post-HSCT Viral Management: Strategies Beyond the Guidelines (ICBMT 2025) - "Despite the integration of Letermovir into standard prophylaxis regimens, breakthrough infections persist, especially beyond D+100, with Korean real - world data showing clinically significant CMV infection (csCMVi) rates rising from 9.5% at 14 weeks to 29.4% by 24 weeks...We present a real -world case of ganciclovir -resistant CMV harbouring the UL97 H520Q mutation, which necessitated sequential therapy with foscarnet and later maribavir...Prophylaxis with oral acyclovir for up to one year reduces early incidence but carries rebound risks and is limited by long -term toxicity and antiviral resistance. The advent of the recombinant zoster vaccine (RZV; Shingrix) offers a promising preventive strategy, particularly in the 6 –24 month window post -transplant...Optimal outcomes require a personalised, adaptive strategy that incorporates novel therapeutics, surveillance tools, and host factors. Through real -world evidence and clinical insight, this lec ture aims to equip..."

Bone Marrow Transplantation • Cytomegalovirus Infection • Graft versus Host Disease • Hematological Malignancies • Herpes Zoster • Immunology • Infectious Disease • Varicella Zoster

An Unusual Presentation of Pan-Esophageal Esophagitis Due to Herpes Simplex Virus in an Immunocompromised Patient (ACG 2025) - "We present a case of HSV esophagitis in an immunocompromised host with unusual findings on upper endoscopy.Case Description/ A 66-year-old male patient with a past medical history of ANCA-positive vasculitis complicated by end-stage renal disease status post kidney transplant (on tacrolimus and mycophenolate mofetil) presented with abdominal pain, odynophagia, nausea, and vomiting...The patient was treated with fluconazole, pantoprazole 40 mg twice daily, and methylprednisolone IV for suspected ANCA vasculitis...He was started on IV acyclovir with improvement in his symptoms and he was discharged with oral valacyclovir. HSV esophagitis is a well-known condition affecting immunocompromised individuals...Although this patient had a classic clinical presentation for infectious esophagitis, his endoscopic findings of severe pan-esophageal esophagitis were atypical for HSV. It is important to have a high suspicion for infectious esophagitis in any immunocompromised patient..."

Clinical • ANCA Vasculitis • Gastrointestinal Disorder • Herpes Simplex • Infectious Disease • Inflammation • Nephrology • Peptic Ulcer • Renal Disease • Vasculitis

Autoimmune Hepatitis in a C282Y Heterozygote Initially Attributed to EBV Hepatitis: A Diagnostic Challenge (ACG 2025) - "Despite a 10-day course of acyclovir, liver enzymes worsened, peaking at ALT 2286 and AST >1500...He was treated with IV methylprednisolone followed by oral prednisone and azathioprine, with rapid clinical and biochemical improvement. This case highlights the diagnostic complexity of AIH in the context of EBV hepatitis and a carrier state for hemochromatosis...Liver Enzymes Trend; Figure 2: Histopathology slide of liver biopsyFigure: Table 1. Elevated Liver Associated Enzymes Evaluation"

Autoimmune Hepatitis • Fibrosis • Genetic Disorders • Hematological Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure

Nephrotoxicity and kidney outcomes in pediatric oncology patients. (PubMed, Nephrol Dial Transplant) - "Acute kidney injury (AKI) is common in children with cancer and is strongly associated with an increased risk of chronic kidney disease (CKD). Awareness is crucial for high-risk patients, particularly those receiving nephrotoxic medications, with a history of multiple AKI episodes or a prior nephrectomy. Comprehensive monitoring strategies should be implemented at diagnosis, during therapy, and during the post-treatment period to enable early detection and timely intervention, ultimately reducing the risk of AKI and its progression to CKD."

Journal • Acute Kidney Injury • Chronic Kidney Disease • Nephrology • Oncology • Pediatrics • Renal Disease

Varicella-zoster virus infection in pregnancy: a case of aseptic meningitis before 20 weeks gestation and review of the literature. (PubMed, Front Med (Lausanne)) - "A 14-day course of acyclovir (5 mg/kg q8h) combined with prednisone achieved complete symptom resolution through a multidisciplinary collaboration (neurology, obstetrics, infectious diseases, pharmacy, and nursing). This represents the fourth reported case of VZV meningitis during pregnancy globally and the first occurring before 20 weeks of gestation with preterm delivery as a unique outcome. Key implications: (1) Early-to-mid gestation VZV infection may affect pregnancy outcomes through distinct mechanisms; (2) multidisciplinary management is critical for optimizing maternal-fetal prognosis; and (3) further investigation is needed to elucidate the relationship between infection timing and preterm birth."

Journal • CNS Disorders • Cough • Herpes Zoster • Infectious Disease • Obstetrics • Pain • Respiratory Diseases • Varicella Zoster

Magnesium Oxide Nanoparticles: A New Frontier in Antiviral Therapy Against Herpes Simplex Virus Type 1. (PubMed, Adv Virol) - "Acyclovir is regarded as the gold standard for treating infections with this virus...The results from the posttreatment assay also showed that MgONPs at concentrations of 300 and 1000 μg/mL led to a significant decrease in viral load with an inhibition rate of 99.5% and 99.7%, respectively. MgONPs can exert their inhibitory effects on HSV-1 in a dose-dependent manner, both directly and through interfering with the replication cycle of the virus."

Journal • CNS Disorders • Herpes Simplex • Infectious Disease • Keratitis • Ocular Inflammation • Ophthalmology

Impact of kidney function on 200 days of antiviral prophylaxis for cytomegalovirus disease in CMV-seronegative recipients of CMV-seropositive donor kidneys Post hoc analysis of a randomized, phase 3 trial of letermovir versus valganciclovir prophylaxis. (PubMed, Am J Transplant) - P3 | "Adult CMV D+R- KTRs were randomized (1:1) post-transplant to letermovir 480 mg (with acyclovir and valganciclovir placebo) or valganciclovir 900 mg (with acyclovir and letermovir placebos) daily for 28-weeks (NCT03443869). In CMV D+R- KTRs, letermovir prophylaxis was associated with less CMV DNAemia compared to valganciclovir in participants with low kidney function during the 200-day prophylaxis period. CLINICAL TRIALS REGISTRATION: ClinicalTrials.gov: NCT03443869, EudraCT: 2017-001055-30."

Journal • P3 data • Retrospective data • Cytomegalovirus Infection • Infectious Disease • Transplantation

A case report of autoimmune glial fibrillary acidic protein astrocytopathy combined with Epstein-Barr virus infection. (PubMed, BMC Neurol) - "It is postulated that the viral infection may have precipitated autoimmune meningoencephalitis. Providing more related cases for the diagnosis of this disease."

Journal • Ataxia • CNS Disorders • Epstein-Barr Virus Infections • Gastrointestinal Disorder • Immunology • Infectious Disease • Inflammatory Bowel Disease • Movement Disorders • GFAP

Epiglottitis of an Unusual Etiology (ACG 2025) - "The patient was started empirically on IV Acyclovir, Fluconazole, Ceftriaxone, and Flagyl...Antibiotics were discontinued and he was discharged home on Valtrex...It has also been estimated that roughly 70% of patients affected with Herpes Zoster laryngitis are concurrently immunocompromised [2]. There have been reported findings of biopsy proven VZV epiglottitis in the order of single digits making this an exceedingly rare diagnostic finding especially in an immunocompetent host.Figure: Esophageal Herpetic Plaques"

Gastrointestinal Disorder • Herpes Zoster • Infectious Disease • Influenza • Otorhinolaryngology • Respiratory Diseases • Varicella Zoster

A Candida Copycat: An Unusual Presentation of HSV Esophagitis (ACG 2025) - "The patient was subsequently instructed to begin a course of acyclovir for HSV esophagitis. This case highlights the diagnostic challenge posed by overlapping presentations of esophageal candidiasis and HSV esophagitis...The Infectious Diseases Society of America (IDSA) recommends fungal microscopy, Gram stain, and histopathological examination for diagnosing esophageal candidiasis, while HSV esophagitis is best confirmed through histopathology and nucleic acid amplification tests (NAAT). Therefore, accurate diagnosis requires a combination of endoscopic evaluation and histopathological confirmation to guide appropriate treatment.Figure: Diffuse white plaque-like lesions throughout the esophagus"

Atrial Fibrillation • Candidiasis • Cardiovascular • Diabetes • Gastrointestinal Disorder • Herpes Simplex • Infectious Disease • Ischemic stroke • Metabolic Disorders

HSV Esophagitis Presenting With Upper GI Bleeding in an Immunocompetent Patient: A Case Report (ACG 2025) - "The patient was treated with acyclovir 500 mg for 14 days, resulting in clinical improvement. This case shows the importance of maintaining a broad differential diagnosis in elderly patients with upper GI bleeding, especially those on anticoagulation...Early endoscopy and histologic confirmation enabled appropriate treatment. HSV esophagitis should be considered in high-risk patients, even without clear immunosuppression to prevent complications such as bleeding, stricture, or perforation.Figure: EGD FindingsFigure: EGD Findings"

Case report • Clinical • Anemia • Atrial Fibrillation • Cardiovascular • Congestive Heart Failure • Gastroenterology • Gastrointestinal Disorder • Heart Failure • Herpes Simplex • Human Immunodeficiency Virus • Infectious Disease • Peptic Ulcer

A Case Report of Idiopathic Esophageal Ulcer in a Renal Transplant Patient Responsive to Steroid Therapy (ACG 2025) - "We describe a case of idiopathic esophageal ulceration ultimately responsive to steroid therapy in an immunosuppressed, HIV-negative renal transplant patient.Case Description/ A 59-year-old female with renal transplant in 2023 for ADPKD presented with odynophagia after a week-long course of doxycycline for outpatient pneumonia treatment...She was initially treated with daily pantoprazole, famotidine, sucralfate and an NG tube was placed for nutrition. Her odynophagia continued and a month later repeat EGD showed persistence of the ulcer for which Vonoprazan was started...Acyclovir was initiated and NG tube was transitioned to a PEG tube to facilitate healing...Due to suspicion for idiopathic giant esophageal ulcer, she was trialed on a prednisone taper of 40 mg, decreasing by 10 mg each week...Staining for CMV, HSV, VZV, EBV negative. No fungal organisms visualized."

Case report • Clinical • Autosomal Dominant Polycystic Kidney Disease • Fibrosis • Gastrointestinal Disorder • Human Immunodeficiency Virus • Immunology • Infectious Disease • Pneumonia • Polycystic Kidney Disease • Respiratory Diseases • Solid Organ Transplantation • Transplantation

Unmasking the Uncommon: A Case Report of Esophagitis Caused by Herpes Simplex Virus (ACG 2025) - "He was fluid resuscitated and started on empiric antibiotics, ceftriaxone and vancomycin...He was started on sucralfate four times daily for 14 days, and heparin was held as safely as possible, pending a repeat EGD in two months...Some studies suggest oral or IV acyclovir may ease symptoms, while others suggest the condition is self-limiting.Figure: 1A: Esophagus Mucosa Severe (LA Class D) ulcerative esophagitis with spontaneous bleeding seen throughout the esophagus starting at 25 cm and going up to 40 cm from the incisors. The GEJ appeared to be at 40 cm and the diaphragmatic pinch was at 45cm compatible with a 5cm hiatal hernia.Figure: 1B"

Case report • Clinical • Cardiovascular • Chronic Kidney Disease • Congestive Heart Failure • Gastroenterology • Gastroesophageal Reflux Disease • Gastrointestinal Disorder • Heart Failure • Herpes Simplex • Infectious Disease • Nephrology • Renal Disease • Septic Shock • Thrombosis

Chicken or the Egg: An Interesting Case of Ogilvie Syndrome in a Schizophrenic Patient with Recent Clozapine Use and Concurrent Acute Herpes Zoster Infection (ACG 2025) - "Acyclovir was initiated for shingles. Timely recognition and management are essential to prevent ischemic complications. This case also underscores the importance of interdisciplinary coordination in managing complex patients with overlapping neuropsychiatric and gastrointestinal conditions."

Clinical • CNS Disorders • Gastrointestinal Disorder • Herpes Zoster • Infectious Disease • Psychiatry • Schizophrenia • Varicella Zoster

Disseminated Herpes Simplex Virus Hepatitis Revealing Underlying Low Grade B-Cell Lymphoma: A Case Report (ACG 2025) - "Dermatology obtained skin swabs positive for HSV-2, prompting initiation of IV acyclovir (10 mg/kg every 8 hours)...Although biopsy findings were nonspecific, the patient's clinical improvement with prompt antiviral therapy underscores the importance of early recognition and treatment in high-risk individuals with HSV hepatitis. This case highlights the need to maintain a broad differential to avoid missing rare but potentially fatal conditions."

Case report • Clinical • B Cell Lymphoma • Dermatology • Fatigue • Hematological Malignancies • Hepatology • Herpes Simplex • Immunology • Infectious Disease • Leukemia • Leukopenia • Lymphoma • Neutropenia • Non-Hodgkin’s Lymphoma

A Case of Hepatitis E Masquerading as Autoimmune Hepatitis (ACG 2025) - "She had been treated empirically with antibiotics, corticosteroids, and acyclovir...Incorporating HEV serologic testing into the workup of acute hepatitis may improve diagnostic accuracy and prevent inappropriate management."Generative AI was used to assist with language refinement in the preparation of this abstract. All clinical content and interpretation were developed and verified by the authors.""

Clinical • Alpha-1 Antitrypsin Deficiency • Autoimmune Hepatitis • Cytomegalovirus Infection • Epstein-Barr Virus Infections • Genetic Disorders • Hepatology • Immunology • Infectious Disease • Inflammation • Liver Failure • Metabolic Disorders • Movement Disorders • Otorhinolaryngology • Pulmonary Disease • Respiratory Diseases

Primary HSV Esophagitis in an Immunocompetent Young Adult: A Diagnostic Challenge (ACG 2025) - "He was started on amoxicillin-clavulanate. However, due to lack of improvement, noticeable tonsillar enlargement, and worsening odynophagia, treatment was escalated with clindamycin and dexamethasone...Empiric treatment with fluconazole, acyclovir, esomeprazole, and continued clindamycin was initiated...Endoscopic images showing esophageal ulcerations and exudates indicative of Herpes Simplex Virus (HSV) infection. The left image shows early-stage ulceration with white exudate, while the right image demonstrates more extensive ulcerations and mucosal damage"

Clinical • Gastrointestinal Disorder • Herpes Simplex • Human Immunodeficiency Virus • Infectious Disease • Otorhinolaryngology

Herpes Esophagitis Due to Cirrhosis-Associated Immune Dysfunction (ACG 2025) - "When diagnosed and treated early, patients usually have a good prognosis. However, complications such as esophageal strictures or perforations may develop in some cases.Figure: Figure 1: Multiple shallow esophageal ulcers separated by normal-appearing mucosa, a pattern suggestive of a viral etiology, most consistent with herpes esophagitis.Figure: Figure 2: Following intravenous acyclovir therapy, the ulcers significantly receded."

Crohn's disease • Fibrosis • Gastroenterology • Gastrointestinal Disorder • Hematological Disorders • Hepatology • Herpes Simplex • Immunology • Infectious Disease • Inflammation • Inflammatory Bowel Disease • Liver Cirrhosis • Peptic Ulcer • Rare Diseases

When Chickenpox Turns Deadly: Acute Hepatitis and Multi-Organ Failure From Primary VZV in an Immunocompetent Adult (ACG 2025) - "On hospital day 3, she developed a diffuse vesicular rash, fevers, and severe abdominal pain in the background of her husband having a primary VZV infection 3 weeks prior, for which valacyclovir was started orally...IV acyclovir as well as N-acetylcysteine (NAC) was started...The rapid progression with high morbidity underscores the importance of prompt recognition and maintaining a high index of suspicion.Figure: Figure 1. Widespread pruritic, vesicular rash over back of the patient (also on face, neck, chest)Figure: Graphic trend of Liver function testing highlighting the peak and subsequent improvement after starting Acyclovir"

Clinical • CNS Disorders • Hepatitis C • Hepatology • Herpes Zoster • Human Immunodeficiency Virus • Infectious Disease • Inflammation • Liver Failure • Musculoskeletal Pain • Pneumonia • Varicella Zoster

A Case of Misleading Findings: Atypical Presentation of HSV Esophagitis in AIDS (ACG 2025) - "Candida esophagitis was presumed, and fluconazole therapy was initiated...Elevated CMV IgG ( >8) led to initiation of ganciclovir. However, esophageal biopsies later identified HSV as the causative agent, and therapy was appropriately switched to acyclovir. Esophagitis occurs in up to 30–50% of patients with AIDS, commonly due to Candida, CMV or HSV...Co-infections and overlapping features further complicate diagnosis in immunocompromised patients. Early biopsy with histopathologic and immunohistochemical analysis is crucial for accurate identification, enabling timely, targeted therapy and avoiding unnecessary broad-spectrum treatments, thereby improving clinical outcomes in this high-risk population.Figure: Figure 1: Endoscopy pictures showing deep, punched - out ulcers (black arrows) in the distal esophagus, suggestive of CytomegalovirusFigure: Figure 2: H&E stain of esophageal mucosa specimen at 20x magnification showing squamous mucosa with ulceration and..."

Clinical • Cough • Cytomegalovirus Infection • Gastrointestinal Disorder • Herpes Simplex • Human Immunodeficiency Virus • Infectious Disease • Pulmonary Disease • Respiratory Diseases • CD4