title: Fatal disseminated varicella zoster infection following zoster vaccination in an immunocompromised patient.
abstract: A 79-year-old man with chronic lymphocytic leukaemia presented with fever and a widespread vesicular rash on 19 November 2014. The patient had not been under immunosuppressive regime for 6 months. He had received a shingles vaccine on 14th October and developed flu-like symptoms after 2 weeks. Intravenous antimicrobial therapy including aciclovir was started. He remained stable with no evidence of systemic involvement. On day 5, he developed respiratory and renal failure that required transfer to intensive care unit. Vesicle fluid, bronchoalveolar lavage and plasma were positive for varicella zoster virus by PCR. Slight clinical improvement allowed extubation on day 16. He subsequently deteriorated and died on day 25. Multiorgan failure was considered the immediate cause of death whereas disseminated varicella zoster infection was stated in the medical certificate as the other condition leading to this outcome. Varicella zoster Oka vaccine strain was detected in vesicle fluid, using PCR.
authors.affiliation: Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: E
authors.initials: E
authors.lastname: Costa
authors.affiliation: Borders General Hospital, Melrose, UK.
authors.forename: J
authors.initials: J
authors.lastname: Buxton
authors.affiliation: Great Ormond St Hospital for Children, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Brown
authors.affiliation: Department of Medical Virology, Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: K E
authors.initials: KE
authors.lastname: Templeton
authors.affiliation: Great Ormond St Hospital for Children, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Breuer
authors.affiliation: Royal Infirmary of Edinburgh, Edinburgh, UK.
authors.forename: I
authors.initials: I
authors.lastname: Johannessen
mesh_terms: D000212:Acyclovir / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D017809:Fatal Outcome; D006562:Herpes Zoster / Q000150:complications / Q000188:drug therapy* / Q000517:prevention & control; D053061:Herpes Zoster Vaccine / Q000009:adverse effects*; D006801:Humans; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000150:complications*; D008297:Male; D051437:Renal Insufficiency / Q000209:etiology; D012131:Respiratory Insufficiency / Q000209:etiology
chemical_list: D053061:Herpes Zoster Vaccine; D000212:Acyclovir