ABDOMINAL-PAIN AS THE INITIAL SYMPTOM OF VISCERAL VARICELLA-ZOSTER INFECTION IN BONE-MARROW TRANSPLANT RECIPIENTS

Varicella tester virus (VZV) infections are an important cause of morb idity after stem cell transplantation (SCT), with no differences in th eir overall incidence between allogeneic and autologous transplants. W e report four patients who developed a disseminated VZV infection with visceral involvement after an allogeneic (n = 3) or autologous (n = 1 ) SCT, In all 4 cases, the initial symptom was severe abdominal pain w hich preceded the appearance of the classical herpetic vesicular skin lesions from two to four days in three cases, while one never develope d skin lesions. The interval from the transplant to the infection rang ed from 5 to 13 months, and all three allogeneic SCT received a T-cell depleted graft, although two suffered from chronic GVHD. All patients had clinical, radiologic and/or biochemical findings indicative of ga strointestinal or visceral involvement, An extensive bibliography revi ew of this specific form of presentation of disseminated VZV infection is presented.The interval from the abdominal pain to the development of the skin lesions has ranged from one to 10 days, and this has led t o a delay in the initiation of specific antiviral therapy in many case s, including our only fatal case. We conclude that an abdominal pain o f unknown origin in this particular clinical setting should always be regarded as a possible prodromal phase of a disseminated VZV infection .