title: Visceral varicella zoster virus infection after allogeneic stem cell transplantation.
abstract: BACKGROUND
  Varicella zoster virus (VZV) disease is one of the major infectious complications that can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Many reports have shown visceral VZV infection, a special type of VZV disease, to be rare. However, few studies so far have included a large number of patients.
  
  
  RESULTS
  Visceral VZV infection was found in 20 (0.8%) of 2411 patients who underwent allo-HSCT at our hospitals. Seventeen (85%) patients were taking immunosuppressive agents at the time of presentation with zoster. The presenting symptom was abdominal pain in 16 patients (80%), unconsciousness in 3 patients (15%), and no symptoms in 1 patient. The mean time interval from allo-HSCT to symptomatic visceral VZV infection was 273 days (103-800 days). The eruptions appeared within 3 days (0-13) after the first symptoms. Treatment with intravenous acyclovir was initiated before the appearance of eruptions in 3 of 18 patients (all 3 survived) with vesicular eruptions, the same day in 12 patients (11 survived, 1 died), and after the appearance in 3 patients (1 survived, 2 died). The overall mortality was 20%.
  
  
  CONCLUSIONS
  In conclusion, these data confirm that the incidence of visceral VZV infection is infrequent, but this disease is serious. When patients being treated with immunosuppressive agents demonstrate abdominal pain or unconsciousness, the possibility of visceral VZV infection should be considered as well as earlier therapeutic intervention.
authors.affiliation: Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan. n-doki@cick.jp
authors.forename: N
authors.initials: N
authors.lastname: Doki
authors.forename: S
authors.initials: S
authors.lastname: Miyawaki
authors.forename: M
authors.initials: M
authors.lastname: Tanaka
authors.forename: D
authors.initials: D
authors.lastname: Kudo
authors.forename: A
authors.initials: A
authors.lastname: Wake
authors.forename: K
authors.initials: K
authors.lastname: Oshima
authors.forename: H
authors.initials: H
authors.lastname: Fujita
authors.forename: T
authors.initials: T
authors.lastname: Uehara
authors.forename: R
authors.initials: R
authors.lastname: Hyo
authors.forename: T
authors.initials: T
authors.lastname: Mori
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.forename: S
authors.initials: S
authors.lastname: Okamoto
authors.forename: H
authors.initials: H
authors.lastname: Sakamaki
mesh_terms: D015746:Abdominal Pain / Q000209:etiology*; D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002908:Chronic Disease; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006562:Herpes Zoster / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000302:isolation & purification; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous / Q000009:adverse effects; D014474:Unconsciousness / Q000209:etiology; D014775:Virus Activation; D014781:Viscera / Q000473:pathology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents; D000212:Acyclovir