title: [Fatal acute visceral disseminated varicella-zoster virus infection in a patient with chronic graft-versus-host disease].
abstract: A 34-year-old woman was admitted for chronic graft-versus-host disease ten months after an unrelated bone marrow transplantation. Cytomegalovirus (CMV) antigenemia on day 5 of hospitalization was negative. Thrombocytopenia occurred on day 9. Laboratory findings revealed severe liver dysfunction on day 13. On day 14, the patient developed interstitial pneumonia and disseminated intravascular coagulation, and died from progressive respiratory failure. Multinucleated giant cells were found in the lung, liver, spleen, esophagus, pancreas and intestine obtained at autopsy. Varicella-zoster virus (VZV) was detected in the blood using the polymerase chain reaction (PCR) technique. CMV, herpes virus type 6 and Epstein-Barr virus were detected in the liver and lung with the PCR technique. We concluded visceral VZV infection was the main cause of her death because of her aggressive clinical course and the histology at autopsy. In this case, chronic GVHD and its immunosuppressive treatment resulted in her fatal VZV reactivation.
authors.affiliation: Division of Hematology, Kanagawa Cancer Center.
authors.forename: Etsuko
authors.initials: E
authors.lastname: Yamazaki
authors.forename: Aki
authors.initials: A
authors.lastname: Kamijoh
authors.forename: Jun
authors.initials: J
authors.lastname: Taguchi
authors.forename: Rie
authors.initials: R
authors.lastname: Hyoh
authors.forename: Shigeki
authors.initials: S
authors.lastname: Motomura
authors.forename: Fumio
authors.initials: F
authors.lastname: Kodama
authors.forename: Shoichi
authors.initials: S
authors.lastname: Kobayashi
authors.forename: Atsuo
authors.initials: A
authors.lastname: Maruta
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagao
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002908:Chronic Disease; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications*; D006562:Herpes Zoster / Q000209:etiology*; D006801:Humans