title: Varicella zoster virus meningoencephalitis after allogeneic hematopoietic stem cell transplantation.
abstract: Although the reactivation of varicella zoster virus (VZV) is a common complication after allogeneic hematopoietic stem cell transplantation (HSCT), VZV meningoencephalitis is a rare life-threatening infectious disease after HSCT. We describe here a patient who developed VZV meningoencephalitis 2 years after human leukocyte antigen-matched unrelated HSCT for acute myeloblastic leukemia. She developed chronic graft-versus-host disease, and cyclosporine (CSA) was continued until 17 months after HSCT. Low-dose acyclovir (ACV) at 200 mg/day was administered to prevent the reactivation of VZV from day -7 to the termination of CSA. At 22 months, she suddenly developed fever, loss of consciousness, and seizure, with generalized skin rash. A high level of VZV DNA was detected in her cerebrospinal fluid (CSF). She was diagnosed to have VZV meningoencephalitis. Intravenous ACV at 30 mg/kg/day was given for 2 months. Although loss of consciousness was quickly resolved, some neurologic symptoms persisted. She did not have any known risk factors for VZV reactivation. Therefore, we should keep in mind that any HSCT recipient may develop VZV meningoencephalitis, and examination of CSF for VZV infection with an empiric administration of ACV may be recommended for HSCT recipients with central nervous system symptoms, even in the absence of skin manifestations.
authors.affiliation: Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Suzuki
authors.forename: M
authors.initials: M
authors.lastname: Ashizawa
authors.forename: S
authors.initials: S
authors.lastname: Okuda
authors.forename: H
authors.initials: H
authors.lastname: Wada
authors.forename: K
authors.initials: K
authors.lastname: Sakamoto
authors.forename: K
authors.initials: K
authors.lastname: Terasako
authors.forename: M
authors.initials: M
authors.lastname: Sato
authors.forename: S-I
authors.initials: SI
authors.lastname: Kimura
authors.forename: M
authors.initials: M
authors.lastname: Kikuchi
authors.forename: H
authors.initials: H
authors.lastname: Nakasone
authors.forename: S
authors.initials: S
authors.lastname: Kako
authors.forename: R
authors.initials: R
authors.lastname: Yamazaki
authors.forename: K
authors.initials: K
authors.lastname: Oshima
authors.forename: J
authors.initials: J
authors.lastname: Nishida
authors.forename: Y
authors.initials: Y
authors.lastname: Kanda
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002555:Cerebrospinal Fluid / Q000821:virology; D020804:Encephalitis, Varicella Zoster / Q000188:drug therapy* / Q000821:virology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D006801:Humans; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir