title: Disseminated, persistent, and fatal infection due to the vaccine strain of varicella-zoster virus in an adult following stem cell transplantation.
abstract: Live attenuated varicella vaccine is recommended for healthy individuals who are susceptible to varicella. Although the vaccine is safe, effective, and used worldwide, serious adverse events have been reported, mainly in immunocompromised patients who subsequently recovered. Here, we describe the fatality of an immunocompromised patient who received the varicella vaccine. His medical history provides a cautionary lens through which to view the decision of when vaccination is appropriate. A middle-aged man with non-Hodgkin lymphoma received chemotherapy and a stem cell transplant. He was vaccinated 4 years post-transplantation, despite diagnosis of a new low-grade lymphoma confined to the lymph nodes. Within 3 months of vaccination, he developed recurrent rashes with fever, malaise, weakness, hepatitis, weight loss, and renal failure. The syndrome was eventually determined to be associated with persistent disseminated zoster caused by the vaccine virus. This case illustrates a circumstance when a live viral vaccine should not be used.
authors.affiliation: Department of Medicine, Oregon Health Science University, Portland.
authors.forename: Preeti
authors.initials: P
authors.lastname: Bhalla
authors.affiliation: Department of Medicine, Oregon Health Science University, Portland Portland Veterans Affairs Medical Center, Oregon.
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Forrest
authors.affiliation: Department of Pathology and Cell Biology.
authors.forename: Michael
authors.initials: M
authors.lastname: Gershon
authors.affiliation: Department of Pathology and Cell Biology.
authors.forename: Yan
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of Pathology and Cell Biology.
authors.forename: Jason
authors.initials: J
authors.lastname: Chen
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Philip
authors.initials: P
authors.lastname: LaRussa
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Sharon
authors.initials: S
authors.lastname: Steinberg
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York.
authors.forename: Anne A
authors.initials: AA
authors.lastname: Gershon
mesh_terms: D019433:Chickenpox Vaccine / Q000009:adverse effects*; D017809:Fatal Outcome; D006566:Herpesviridae Infections / Q000175:diagnosis* / Q000473:pathology*; D014645:Herpesvirus 3, Human / Q000302:isolation & purification*; D006801:Humans; D016867:Immunocompromised Host; D008228:Lymphoma, Non-Hodgkin / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D033581:Stem Cell Transplantation / Q000009:adverse effects*
chemical_list: D019433:Chickenpox Vaccine
keywords: granulomas; vOka; vaccine; varicella; zoster