VISCERAL VARICELLA-ZOSTER INFECTION AFTER BONE-MARROW TRANSPLANTATIONWITHOUT SKIN INVOLVEMENT AND THE USE OF PCR FOR DIAGNOSIS

A 41-year-old patient with acute myeloid leukemia was transplanted fro m an HLA-identical but ABO-incompatible sibling. The post-transplant c ourse was complicated by pure erythrocyte aplasia and mild chronic gra ft-versus-host disease. Eleven months after transplant while on steroi d therapy she developed abdominal pain rapidly followed by fatal fulmi nant hepatic failure. Varicella zoster virus (VZV) was detected using the polymerase chain reaction from blood and liver obtained at necrops y even though no skin manifestations of VZV were present. This case co nfirms previous reports of visceral VZV infection in the absence of sk in lesions thus emphasising the importance of suspecting the presence of VZV in this clinical setting and outlines the possible value of PCR in the rapid diagnosis of infection.