Severe hepatitis associated with varicella zoster virus infection in a patient with diffuse large B cell lymphoma treated with rituximab-CHOP chemotherapy.
Severe disseminated varicella zoster virus (VZV) infection rarely occurs in patients who are not recipients of hematopoietic stem cell transplantation. This report concerns severe disseminated VZV infection in a diffuse large B cell lymphoma (DLBCL) patient treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The patient was an 82-year-old male with DLBCL who had a history of type II diabetes mellitus. He incurred VZV infection with severe hepatitis and disseminated intravascular coagulopathy after three courses of R-CHOP. When the VZV infection occurred, anti-VZV IgG was not detected and lymphopenia was observed. We initiated treatment with acyclovir, immunoglobulin, and thrombomodulin alpha, and rescued this patient. We suggest that the use of chemotherapy for immune-suppressed elderly lymphoma patients may involve the risk of severe VZV infection.
Department of Hematology and Medical Oncology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake 470-1192, Japan. aokamoto@fijita-hu.ac.jp
Akinao
A
Okamoto
Akihiro
A
Abe
Masataka
M
Okamoto
Tsukane
T
Kobayashi
Tomohiko
T
Terazawa
Yoko
Y
Inaguma
Masutaka
M
Tokuda
Masamitsu
M
Yanada
Satoko
S
Morishima
Tadaharu
T
Kanie
Yukiya
Y
Yamamoto
Motohiro
M
Tsuzuki
Yoshiki
Y
Akatsuka
Shuichi
S
Mizuta
Tetsushi
T
Yoshikawa
Nobuhiko
N
Emi
D000369:Aged, 80 and over; D058846:Antibodies, Monoclonal, Murine-Derived / Q000009:adverse effects / Q000627:therapeutic use; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000009:adverse effects / Q000627:therapeutic use; D004317:Doxorubicin / Q000009:adverse effects / Q000627:therapeutic use; D006505:Hepatitis / Q000175:diagnosis / Q000209:etiology*; D006562:Herpes Zoster / Q000175:diagnosis / Q000209:etiology*; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D011241:Prednisone / Q000009:adverse effects / Q000627:therapeutic use; D000069283:Rituximab; D014750:Vincristine / Q000009:adverse effects / Q000627:therapeutic use
D058846:Antibodies, Monoclonal, Murine-Derived; D000914:Antibodies, Viral; C571759:R-CHOP protocol; D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone