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Atypical varicella zoster infection associated with hemophagocytic lymphohistiocytosis
Author(s) -
van der Werff ten Bosch Jutte E.,
Kollen Wouter J.W.,
Ball Lynne M.,
Brinkman Danielle M.C.,
Vossen Anne C.T.M.,
Lankester Arjan C.,
Egeler R. Maarten,
Bredius Robbert G.M.
Publication year - 2009
Publication title -
pediatric blood and cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.116
H-Index - 105
eISSN - 1545-5017
pISSN - 1545-5009
DOI - 10.1002/pbc.22041
Subject(s) - medicine , hemophagocytic lymphohistiocytosis , dermatome , varicella zoster virus , blood cancer , disease , dermatology , abdominal pain , virus , pediatrics , immunology , cancer , surgery
Abstract Two adolescents, on immunosuppressive therapy for graft‐versus‐host disease, developed hemophagocytic lymphohistiocytosis (HLH) after varicella zoster virus (VZV) reactivation. In the absence of dermatome restricted characteristic skin lesions, VZV reactivation was not immediately recognized and treatment with acyclovir was delayed. The first patient developed optical neuritis and died 2 months after the VZV episode due to massive intracranial hemorrhage. The second patient presented with severe abdominal pain and pancreatitis, followed by atypical skin eruptions, which prompted a faster diagnosis. Both patients recovered from their HLH, the first patient being successfully treated with immunosuppressive agents and the second with VZV treatment only. These two cases demonstrate the difficulties in recognizing VZV reactivation, and in order to start adequate and timely treatment, the need to consider VZV as a possible cause of HLH in severely immunocompromised patients. Pediatr Blood Cancer 2009;53:226–228. © 2009 Wiley‐Liss, Inc.