Acute Abdominal Pain Preceding Cutaneous Manifestations of Varicella Zoster Infection after Allogeneic Bone Marrow Transplantation.

Itoh, Mitsuru; Kawaguchi, Shinya; Yago, Kazuo; Shimada, Hideto; Muro, Hiroyuki

doi:10.1620/tjem.195.61

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…This complication occurs in approximately 1 in 250 VZV-seropositive allograft recipients, and a review of the literature indicates that this highly fatal complication continues to be a significant clinical problem. 1,[10][11][12][13][14][15][16][17][18][19][20][21][22][23]25 An additional indirect benefit is the risk reduction for susceptible VZV-seronegative individuals.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Furthermore, hepatic or gastrointestinal VZV disease may occur with few or no skin lesions, which often delays the diagnosis and leads to a high mortality. 1,[10][11][12][13][14][15][16][17][18][19][20][21][22][23] Severe ocular complications and VZV myelitis may also occur. 1,24,25 Finally, patients with VZV reactivation disease, especially when disseminated, may expose susceptible individuals to VZV.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Boeckh

Kim

Flowers

et al. 2006

Blood

232

185

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Varicella-zoster virus (VZV) disease occurs in 30% of allogeneic hematopoietic cell transplant recipients who had a history of VZV infection. A safe and effective prevention strategy has not been established. In a double-blind controlled trial, 77 hematopoietic cell transplant recipients at risk for VZV reactivation were randomized to acyclovir 800 mg twice daily or placebo given from 1 to 2 months until 1 year after transplantation. VZV disease at 1 year was the primary end point; VZV disease after discontinuation of prophylaxis, VZV-specific T-cell immunity, herpes simplex virus (HSV) infection, cytomegalovirus (CMV) disease, survival, and safety were secondary end points. Acyclovir significantly reduced VZV infections at 1 year after transplantation (HR, 0.16; 95% CI, 0.035-0.74; P ‫؍‬ .006). In the postintervention observation period, this difference was not statistically significant (2 years: HR, 0.52; 95% CI, 0.21-1.3; 5 years: HR, 0.76; 95% CI, 0.36-1.6). There was no statistically significant difference in reconstitution of VZVspecific T-helper cell responses, HSV infections, CMV disease, chronic graftversus-host disease, and overall survival between the groups. Acyclovir was well tolerated. Post-study VZV disease predominantly occurred in patients with continued need for systemic immunosuppression. In conclusion, acyclovir effectively and safely prevents VZV disease during the first year after hematopoietic cell transplantation. Periods of prophylaxis longer than 12 months may be beneficial for those hematopoietic cell transplant recipients on continued immune suppression.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Boeckh

Kim

Flowers

et al. 2006

Blood

232

185

View full text Add to dashboard Cite

show abstract

“…In addition, case reports have noted that severe epigastric pain from gastric and/or esophageal involvement may be the initial symptom. [10][11][12][13] Severe hyponatremia, first described in 1983, is also reported in conjunction with visceral VZV reactivation. 14 The reasons for the alterations in serum sodium are unclear but may be a result of direct central nervous system (CNS) involvement as illustrated by the CNS PCR positivity shown in patient no.…”

Section: Discussionmentioning

confidence: 98%

Visceral Varicella Zoster Virus (VZV) After Allogeneic Hematopoietic Stem Cell Transplant (HSCT) in Pediatric Patients With Chronic Graft-Versus-Host Disease (cGVHD)

Peritz

Duncan²,

Kurek³

et al. 2008

Journal of Pediatric Hematology/Oncology

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Reactivation of latent varicella zoster virus is one infectious complication associated with the extensive immunosuppression necessary for hematopoietic stem cell transplant. Most cases are limited to skin and mortality is low. Isolated visceral zoster is rare, presenting with ileus/abdominal pain, hepatitis, and/or hyponatremia. We present 2 cases of visceral varicella zoster virus in adolescents with chronic graft-versus-host disease after hematopoietic stem cell transplant. Both presented with elevated liver enzymes, severe abdominal pain, and hyponatremia but lacked cutaneous involvement. Both received high-dose acyclovir and showed improvement, but eventually expired from hepatic failure. The diagnosis of visceral zoster can be difficult especially without cutaneous manifestations. Vigilance is necessary in patients with chronic graft-versus-host disease, abdominal pain, and/or hepatitis and antiviral therapy should be initiated promptly.

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“…It has been known that patients with combined hepatorenal dysfunctions have an increased risk for reactivation of HSV [4]. Furthermore, CD4+/CD8+ depleted patients with liver cirrhosis have an increased risk for HSV recurrence [5, 6, 7]. Prophylactic antiviral medication can be chosen at least in patients at risk for CMV infection.…”

Section: Discussionmentioning

confidence: 99%

“…HSV manifestations after transplantation have been described; however, usually a time delay between organ transplantation and HSV infection – corresponding with the time necessary for the achievement of full therapeutic immunosuppression – is seen. The herpes virus group consists of the Herpes zoster virus and the Herpes simplex virus [1, 4], the former occurring much more often as a painful post-transplant infection [5, 6, 7]. Infections or recurrences of HSV after transplantation are much more uncommon and comprise case reports describing esophagitis and nephritis [8, 9].…”

Section: Introductionmentioning

confidence: 99%

Seronegative <i>Herpes simplex</i> Associated Esophagogastric Ulcer after Liver Transplantation

Matevossian

Doll²,

Weirich³

et al. 2008

Case Rep Gastroenterol

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Herpes simplex infection is characterized by acute or subacute infection, often followed by a chronic carrier state. Consecutive recurrences may flare up if immunocompromise occurs. Herpes simplex associated esophagitis or duodenal ulcer have been reported in immunocompromised patients due to neoplasm, HIV/AIDS or therapeutically induced immune deficiency. Here we report the case of an HSV-DNA seronegative patient who developed grade III dysphagia 13 days after allogeneic liver transplantation. Endoscopy revealed an esophageal-gastric ulcer, and biopsy histopathology showed a distinct fibroplastic and capillary ulcer pattern highly suspicious for viral infection. Immunohistochemistry staining revealed a distinct nuclear positive anti-HSV reaction. Antiviral therapy with acyclovir and high-dose PPI led to a complete revision of clinical symptoms within 48 h. Repeat control endoscopy after 7 days showed complete healing of the former ulcer site at the gastroesophageal junction. Although the incidence of post-transplantation Herpes simplex induced gastroesophageal disease is low, the viral HSV ulcer may be included into a differential diagnosis if dysphagia occurs after transplantation even if HSV-DNA PCR is negative.

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Acute Abdominal Pain Preceding Cutaneous Manifestations of Varicella Zoster Infection after Allogeneic Bone Marrow Transplantation.

Cited by 6 publications

References 2 publications

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Long-term acyclovir for prevention of varicella zoster virus disease after allogeneic hematopoietic cell transplantation—a randomized double-blind placebo-controlled study

Visceral Varicella Zoster Virus (VZV) After Allogeneic Hematopoietic Stem Cell Transplant (HSCT) in Pediatric Patients With Chronic Graft-Versus-Host Disease (cGVHD)

Seronegative <i>Herpes simplex</i> Associated Esophagogastric Ulcer after Liver Transplantation

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