Valacyclovir Hydrochloride

We read with interest the work by Toti and colleagues, who have recently reported a case of a neonate with asymptomatic congenital cytomegalovirus (cCMV) infection at birth after in-utero treatment with valacyclovir (VCV) and a neg. amniocentesis .Since VCV has been implemented at our clinic in Jan. 2021 for prevention of CMV transplacental transmission in pregnant women with primary infection within 24 wk [2], we have managed two cases with similar characteristics as the one reported by Toti and coworkers.In this case a 37-yr-old gravida 2, para 1 was diagnosed with primary CMV infection early in pregnancy. Maternal serol. performed at 6 2/7 wk showed CMV IgG 16.5 U/mL (CLIA, pos. ≥ 14), IgM 58.5 U/mL (CLIA, pos. ≥ 22), IgM 2.15 index (ELFA, pos. ≥ 0.9), IgG avidity not performed. Viral DNA was identified in blood (8001 copies/mL), urine (1040 copies/mL), and saliva (1877 copies/mL) at 9 5/7 wk.After counseling, the woman was started on VCV (2 g every 6 h) at 10 wk, with viremia becoming neg. at 12 1/7 wk.Amniocentesis was performed at 19 6/7 wk and was neg.; therapy was discontinued at 26 wk.Virol. monitoring showed pos. viremia at 32 wk (505 copies/mL), a few days after the woman was diagnosed with pauci-symptomatic SARS-CoV-2 infection.Thus, postnatal antiviral treatment was not administered. Follow-up at 30 mo was regular, with appropriate neurodevelopment score (Bayley-III) and normal hearing.

We present a case of a woman in her 50s with relapsing-remitting multiple sclerosis, treated with diroximel fumarate, who developed an itching, burning vesicular rash following a C3 dermatomal distribution on her left face and neck. She was diagnosed with herpes zoster, treated with valacyclovir and gabapentin, and made a full recovery. Ensuring patients are protected against varicella-zoster virus before starting diroximel fumarate can prevent this painful infection. Thus, we recommend vaccination against the varicella-zoster virus prior to diroximel fumarate initiation be incorporated as the standard of care.