Vedolizumab and chickenpox in immune patient during pregnancy

Abstract

Vedolizumab (VDZ) is a humanized immunoglobulin G1 monoclonal antibody approved for use in adults affected by moderately to severely active Crohn’s disease (CD) and ulcerative colitis (UC). In accordance with the Food and Drug Administration (FDA), VDZ is safe during pregnancy. Immunosuppressive drugs increase the risk of infections especially when used in combination, but some treatments may also expose the patients to the reactivation of latent infections. A 39-years old pregnant woman G1 P0 started immunosuppressive therapy with Vedolizumab, after the failure of previous treatments. She had already been tested for HBV, EBV and VZV, in addition to previous serology, resulting in immunity. At the 12 weeks of pregnancy, a first suspicious symptomatology for VZV began to appear and chickenpox caused by Varicella-Zoster virus was suspected. Blood tests showed a strong positivization of viral DNA in the blood. The patient decided to terminate the pregnancy for the fear of congenital chickenpox syndrome. In this case we observed an unexpected viral reactivation to an extent like a first infection although the patient was immune. It is therefore essential to carefully evaluate the administration of Vedolizumab in the first trimester, underlining that a reactivation of the VZV and the manifestation of chickenpox is possible even if the women was cataloged as immune.