Visceral varicella zoster virus (VZV) after allogeneic hematopoietic stem cell transplant (HSCT) in pediatric patients with chronic graft-versus-host disease (cGVHD).
Reactivation of latent varicella zoster virus is one infectious complication associated with the extensive immunosuppression necessary for hematopoietic stem cell transplant. Most cases are limited to skin and mortality is low. Isolated visceral zoster is rare, presenting with ileus/abdominal pain, hepatitis, and/or hyponatremia. We present 2 cases of visceral varicella zoster virus in adolescents with chronic graft-versus-host disease after hematopoietic stem cell transplant. Both presented with elevated liver enzymes, severe abdominal pain, and hyponatremia but lacked cutaneous involvement. Both received high-dose acyclovir and showed improvement, but eventually expired from hepatic failure. The diagnosis of visceral zoster can be difficult especially without cutaneous manifestations. Vigilance is necessary in patients with chronic graft-versus-host disease, abdominal pain, and/or hepatitis and antiviral therapy should be initiated promptly.
Peritz
David C
DC
Dana-Farber Cancer Institute, Children's Hospital, Boston, MA, USA. David_Peritz@dfci.harvard.edu
Duncan
Christine
C
Kurek
Kyle
K
Perez-Atayde
Antonio R
AR
Lehmann
Leslie E
LE
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D002908:Chronic Disease; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006562:Herpes Zoster / Q000175:diagnosis / Q000209:etiology*; D014645:Herpesvirus 3, Human / Q000502:physiology*; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy; D009894:Opportunistic Infections / Q000175:diagnosis / Q000209:etiology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy; D014184:Transplantation, Homologous; D014775:Virus Activation; D014781:Viscera; D055815:Young Adult
D000998:Antiviral Agents; D000212:Acyclovir