Disseminated zoster, hyponatraemia, severe abdominal pain and leukaemia relapse: recognition of a new clinical quartet after bone marrow transplantation

Reactivation of varicella‐zoster virus (VZV) is one of the commonest complications after stem cell transplantation, and often presents with atypical manifestations. We describe two unusual cases of occult disseminated zoster in allogeneic stem cell transplant recipients, presenting as severe abdominal pain and syndrome of inappropriate antidiuretic hormone secretion/hyponatraemia, and accompanied by leukaemia relapse. There was complete clinical recovery with high‐dose aciclovir and intravenous immunoglobulin. Prompt treatment of leukaemia relapse also resulted in complete remission. A possible immunological link between concurrent breakdown of immune control of VZV and leukaemia is discussed.

[1]  K. Yuen,et al.  Clinical characteristics of and risk factors for herpes zoster after hematopoietic stem cell transplantation. , 2002, Haematologica.

[2]  L. McIlwaine,et al.  Inappropriate antidiuretic hormone secretion, abdominal pain and disseminated varicella-zoster virus infection: an unusual and fatal triad in a patient 13 months post Rituximab and autologous stem cell transplantation. , 2001, Clinical and laboratory haematology.

[3]  W. Au,et al.  Fulminant molluscum contagiosum infection and concomitant leukaemia cutis after bone marrow transplantation for chronic myeloid leukaemia , 2000, The British journal of dermatology.

[4]  N. Horvath,et al.  Inappropriate antidiuretic hormone secretion, abdominal pain and disseminated varicella-zoster virus infection: an unusual triad in a patient 6 months post mini-allogeneic peripheral stem cell transplant for chronic myeloid leukemia , 2000, Bone Marrow Transplantation.

[5]  T. Masaoka,et al.  Acute abdomen without cutaneous signs of varicella zoster virus infection as a late complication of allogeneic bone marrow transplantation: importance of empiric therapy with acyclovir , 2000, Bone Marrow Transplantation.

[6]  J. Griffith,et al.  Varicella zoster virus infections following allogeneic bone marrow transplantation: frequency, risk factors, and clinical outcome. , 2000, Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation.

[7]  D. David,et al.  Original ContributionsVisceral Varicella-Zoster after bone marrow transplantation: report of a case series and review of the literature , 1998 .

[8]  B. Paz,et al.  Visceral Varicella-Zoster after bone marrow transplantation: report of a case series and review of the literature , 1998, American Journal of Gastroenterology.

[9]  A. Lazzarin,et al.  Varicella-zoster virus (VZV) DNA in cerebrospinal fluid of patients infected with human immunodeficiency virus: VZV disease of the central nervous system or subclinical reactivation of VZV infection? , 1997, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[10]  A. Sato,et al.  Varicella pneumonia in a healthy adult presenting with severe respiratory failure. , 1996, Internal medicine.

[11]  E. Estirado,et al.  Syndrome of inappropriate antidiuretic hormone secretion and herpes zoster infection: 1. Report of this association in a patient suffering from AIDS. , 1994, Nephron.

[12]  A. Nagler,et al.  Inappropriate antidiuretic hormone secretion (SIADH) preceding skin manifestations of disseminated varicella zoster virus infection post-BMT. , 1993, Bone marrow transplantation.

[13]  R. Jones,et al.  Fatal noncutaneous visceral infection with varicella-zoster virus in a patient with lymphoma after autologous bone marrow transplantation. , 1993, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[14]  S. Nimer,et al.  Abdominal presentation of varicella-zoster infection in recipients of allogeneic bone marrow transplantation. , 1991, Bone marrow transplantation.

[15]  J. Jones,et al.  Herpes zoster infection of the chest wall and the syndrome of inappropriate antidiuretic hormone secretion. , 1990, Southern medical journal.

[16]  N. Estes,et al.  Disseminated varicella-zoster virus infection with the syndrome of inappropriate antidiuretic hormone. , 1983, Archives of internal medicine.