Fatal varicella zoster virus encephalitis in two patients following allogeneic hematopoietic stem cell transplantation.
BACKGROUND
Reduced cellular immunocompetence following allogeneic hematopoietic stem cell transplantation (aHSCT) increases susceptibility to viral infections. Varicella zoster virus (VZV) reactivation in this setting most commonly manifests as dermatomal herpes zoster but in some cases life-threatening VZV encephalitis occurs.


RESULTS
We describe the cases of two patients who presented with shingles 3 and 18 months, respectively, after HLA-matched peripheral blood stem cell transplantation (PBSCT). Unfortunately, in the further clinical course both patients developed fatal VZV encephalitis, despite initial high-dose intravenous therapy with acyclovir and in one case with additional VZV-immunoglobulin.


CONCLUSIONS
These two cases suggest that rapid intervention with systemic treatment is warranted and raise the question whether initial combination therapy with intravenous acyclovir and foscarnet, VZV vaccination or long-term low-dose acyclovir are needed to improve treatment and clinical outcome in immunocompromised patients, having undergone allogeneic HSCT.
Hackanson
Björn
B
Department of Hematology/Oncology, Freiburg University Medical Center, Freiburg, Germany. hackanson@mm11.ukl.uni-freiburg.de
Zeiser
Robert
R
Bley
Thorsten A
TA
Pantazis
Georgios
G
Huzly
Daniela
D
Bertz
Hartmut
H
Finke
Jürgen
J
D000212:Acyclovir / Q000627:therapeutic use; D000368:Aged; D020804:Encephalitis, Varicella Zoster / Q000188:drug therapy / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006562:Herpes Zoster / Q000209:etiology; D006801:Humans; D016867:Immunocompromised Host; D007136:Immunoglobulins / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged
D007136:Immunoglobulins; D000212:Acyclovir