Subject(s)
Malaria, Falciparum/complications , Pancytopenia/etiology , Adult , Blood Cell Count , Humans , Male , Thrombocytopenia/etiologyABSTRACT
BACKGROUND: Leukemeia and lymphoproliferative disease are associated with a high risk of varicela-zoster virus (VZV) infection. Although infrequent, visceral involvement can be fatal. We report two cases of patients presenting severe VZV infection after bone marrow transplantation. CASE REPORTS: The first patient was a 42-year old man who received an allogeneic bone marrow transplantation for chronic myelogenous leukemia. A severe graft-versus-host reaction occurred. Three months after discontinuing VZV prophylaxis, VZV transverse myelitis was diagnosed, leading to death despite prompt treatment with acyclovir. The second patient was a 42-year-old woman treated with autologous bone marrow transplantation for lymphoma. She developed acute viral pancreatitis one month after discontinuing VZV prophylaxis. Recovery was achieved with intravenous treatment. DISCUSSION: These two cases illustrate the potential gravity of VZV infection after bone marrow transplantation. These observations point to the need for revisiting the duration of VZV prophylaxis.
Subject(s)
Bone Marrow Transplantation , Herpes Zoster/diagnosis , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Lymphoma, Large-Cell, Immunoblastic/therapy , Myelitis, Transverse/diagnosis , Opportunistic Infections/diagnosis , Pancreatitis/diagnosis , Adult , Antiviral Agents/administration & dosage , Antiviral Agents/adverse effects , Drug Therapy, Combination , Fatal Outcome , Female , Graft vs Host Disease/drug therapy , Herpes Zoster/prevention & control , Humans , Immunosuppressive Agents/administration & dosage , Immunosuppressive Agents/adverse effects , Lymphocyte Depletion , Magnetic Resonance Imaging , Male , Myelitis, Transverse/prevention & control , Opportunistic Infections/prevention & control , Pancreatitis/prevention & control , Spinal Cord/pathology , Tomography, X-Ray ComputedABSTRACT
INTRODUCTION: In hematologic malignancies, respiratory syncytial viral infections can be explained by neutropenia, and cellular and humoral immunodepression, and may cause severe respiratory infections. EXEGESIS: Four patients with hematologic malignancies developed a severe respiratory syncytial virus infection. Three of them had previously received autologous bone marrow transplantation (ABMT). Progress was favorable for three patients. One patient died of acute respiratory failure. CONCLUSION: When such patients present with respiratory symptoms, especially during the winter months, they should be screened for RSV. Bronchoalveolar lavage allowed quick and accurate diagnosis by immunofluorescence. Treatment with nebulized ribavirin is controversial. Its use may be interesting in patients with high-risk factors (intensive chemotherapy, ABMT, diffuse pneumonia with hypoxemia).
