title: Disseminated herpes zoster infection initially presenting with abdominal pain in patients with lymphoma undergoing conventional chemotherapy: A report of three cases.
abstract: Visceral disseminated varicella zoster virus (VZV) disease has a high mortality rate, and occurs in immunocompromised hosts, mostly subsequent to allogeneic stem cell transplantation. Only a few cases of this disease that onset during conventional chemotherapy in patients with lymphoma have been reported. The present study reports the cases of 3 patients with disseminated and visceral VZV infection undergoing treatment for follicular lymphoma, diffuse large B-cell lymphoma and peripheral T-cell lymphoma, not otherwise specified. All 3 patients presented with initial symptoms of abdominal pain, and 2 patients demonstrated syndrome of inappropriate antidiuretic hormone and hepatitis. All patients developed widespread cutaneous dissemination, and all had a low cluster of differentiation 4 cell count or lymphocyte count at the time of VZV diagnosis and at least 4 month prior. With intravenous systemic acyclovir therapy (Cases 1 and 3, 1500 mg/day; Case 2, 750 mg/day), the patients achieved complete recovery by day 14 of therapy. Visceral disseminated VZV infection is not limited to patients undergoing stem cell transplantation, and may present with abdominal pain with or without skin eruption. Visceral infection may take a poor clinical course, therefore, in patients with prolonged duration of low lymphocyte count and/or long-term use of steroids, the prophylactic use of acyclovir may be considered.
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan; Department of Medical Oncology, Graduate School of Medicine, Chiba University Hospital, Chiba, Chiba 260-8670, Japan.
authors.forename: Hitomi Sumiyoshi
authors.initials: HS
authors.lastname: Okuma
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Makita
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kitahara
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Suguru
authors.initials: S
authors.lastname: Fukuhara
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Wataru
authors.initials: W
authors.lastname: Munakata
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Suzuki
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Dai
authors.initials: D
authors.lastname: Maruyama
authors.affiliation: Department of Hematology, National Cancer Center Hospital, Tokyo 104-0045, Japan.
authors.forename: Kensei
authors.initials: K
authors.lastname: Tobinai
keywords: cutaneous dissemination; infectious complications; lymphoma chemotherapy; varicella zoster virus; visceral dissemination