title: Sequential Onset of Varicella-Zoster Virus Encephalomeningitis and Progressive Multifocal Leukoencephalopathy in an Allogeneic Hematopoietic Stem Cell Transplant Recipient.
abstract: Here, we describe a case of sequential varicella-zoster virus encephalomeningitis and progressive multifocal leukoencephalopathy following an allogeneic hematopoietic stem cell transplant procedure. A 37-year-old male patient presented with fever, incomplete paralysis of bilateral legs, and bullous eruptions 8 months after allogeneic transplant. Polymerase chain reaction assays of cerebrospinal fluid samples for varicella-zoster virus were positive. Bullous eruptions and incomplete paralysis of bilateral legs improved after administration of acyclovir. However, higher brain dysfunction was present and getting worse. We detected no herpes simplex virus, varicella-zoster virus, Cytomegalovirus, human herpes virus 6, Epstein-Barr virus, or JC virus in cerebrospinal fluid samples with polymerase chain reaction assays. Pathologic findings and polymerase chain reaction assays with brain biopsy samples revealed that the patient had progressive multifocal leukoencephalopathy. This is the first report of a case showing dual central nervous system infections due to varicella-zoster virus and JC virus after allogeneic stem cell transplant.
authors.affiliation: From the Department of Hematology and Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Kusakabe
authors.forename: Jun
authors.initials: J
authors.lastname: Toda
authors.forename: Kenji
authors.initials: K
authors.lastname: Ohshima
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Masaie
authors.forename: Toshinari
authors.initials: T
authors.lastname: Yagi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Yoshida
authors.forename: Jun
authors.initials: J
authors.lastname: Ishikawa
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D001706:Biopsy; D018450:Disease Progression; D017809:Fatal Outcome; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D014645:Herpesvirus 3, Human / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity*; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007577:JC Virus / Q000187:drug effects / Q000276:immunology / Q000472:pathogenicity*; D007968:Leukoencephalopathy, Progressive Multifocal / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008590:Meningoencephalitis / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D009894:Opportunistic Infections / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D000073618:Varicella Zoster Virus Infection / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000821:virology*; D014775:Virus Activation
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents