Herpes zoster ophthalmicus following bone marrow transplantation in children

Abstract

Summary:Varicella zoster virus (VZV) infection is a frequent complication following bone marrow transplantation (BMT). Involvement of the ophthalmic division of the trigeminal nerve, herpes zoster ophthalmicus (HZO), can result in significant and potentially vision-threatening ocular complications. We report the frequency and characteristics of HZO following BMT, including the timing of infection, treatment, ocular complications, and visual outcome. Between 1983 and 1997, 572 patients underwent BMT and seven children developed HZO at a median of 150 days following transplantation. All but one of the children had undergone allogeneic BMT. All of the children were treated with acyclovir after onset of the rash but none had received prophylactic therapy. All seven children developed ocular complications within the first 4 weeks following the onset of the dermatomal rash but none reported any symptoms during this period. Complications included keratitis in six, anterior uveitis in three and scleritis in one. Keratitis was an early complication developing within the first 4 weeks, while anterior uveitis and scleritis occurred later in the course of the disease. The high frequency of ocular complications and lack of symptoms in children with HZO following BMT suggests that early ophthalmologic evaluation is warranted in this group of patients. Prompt diagnosis and treatment of ocular complications is essential in the prevention of acute and long-term ocular sequelae in these children. Keywords: herpes zoster ophthalmicus; bone marrow transplantation; varicella zoster; keratitis; uveitis; scleritis Varicella zoster virus (VZV) infection is a relatively frequent complication following autologous and allogeneic BMT. [1][2][3][4][5][6] The clinical course of zoster in these immunosuppressed patients tends to be more severe and prolonged due to the profound impairment in cellular immunity following transplantation. VZV infection may develop as a primary infection or more commonly, reactivation of latent infection typically producing dermatomal zoster. 6 In most series, the risk for infection appears to be highest during the 6-9 months following transplantation and up to 30% of patients who develop VZV following BMT will develop complications. [3][4][5][6] Involvement of the ophthalmic division of the trigeminal nerve -herpes zoster ophthalmicus -can result in serious and potentially vision-threatening ocular complications. 7 In adults, up to 72% of patients will develop ocular complications. 8 However, because HZO is uncommon in the pediatric population there is little information on the nature of the disease in children. 9 The purpose of this study was to describe the frequency and characteristics of HZO in children following BMT. Patients and methodsTo identify all children developing HZO following BMT, a computerized search of the BMT database at St Jude Children's Research Hospital in Memphis, TN was performed. All patients with a diagnosis of varicella zoster involving the ophthalmic division of the trigeminal nerve f...

Management of HSV, VZV and EBV infections in patients with hematological malignancies and after SCT: guidelines from the Second European Conference on Infections in Leukemia

“…88,89 Elevated levels of liver aminotransferases may be the first sign of reactivation of VZV after SCT. 90 There are several case reports describing severe epigastric pain due to VZV gastritis, [91][92][93] and other reports of abdominal pain, hepatitis and melena, 94 paralytic ileus and ascites, 95 severe abdominal pain together with inappropriate antidiuretic hormone secretion/hyponatraemia, 96,97 HZ ophthalmicus 98 and meningo-encephalitis. 99,100 Diagnosis Culture of VZV is not as easy as for HSV.…”

Ophthalmic manifestations of acute leukaemias: the ophthalmologist's role

“…59 Herpes zoster can also cause peripheral corneal ulcer, keratitis, and scleritis. 61 Mumps virus has been reported to be a cause of granulomatous uveitis. 62 Fungi are common causes of ocular infection in leukaemias.…”

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

“…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. 26 This can cause major disruptions in health care settings that treat immunosuppressed susceptible individuals.…”