Generalized Varicella Zoster Virus Infection with Pseudomembranous Tracheobronchitis following a High-Risk Kidney Transplant Protocol

Kidney transplant recipients are susceptible to infections. We present a middle-aged woman who underwent a high-risk immunosuppressive treatment protocol due to a pre-transplant immunization. Six weeks after transplantation she developed severe respiratory failure and endotracheal intubation was required. Bronchoscopy revealed extensive endobronchial membranes, and the lavage fluid tested positive for Pseudomonas aeruginosa. After repeated bronchoscopic removal of membranes, she developed a generalized vesicular rash, positive for Varicella zoster virus, later also identified in the bronchial fluid. After 34 days on mechanical ventilation, she was successfully decannulated and could be discharged from hospital three months later, although still in need of a nasogastric tube for feeding, with a functioning kidney graft. This report underscores the significance of herpes viruses as potential contributors to severe respiratory infections in organ transplant recipients, alongside highlighting the atypical manifestations of bacterial infections.