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

Severe abdominal pain followed by inappropriate antidiuretic hormone secret ion (SIADH) preceding by several days the skin manifestation of varicella-z oster virus (VZV) infection in an immunocompromised patient is described. T his is a rare presentation of a severe infection described previously only once in a chronic myeloid leukemia (CML) patient 5 months post allo-BMT dur ing immunosuppressive treatment with cyclosporin A. This is the first case described in the setting of non-myeloablative preparation with fludarabine and melphalan and followed by donor leukocyte infusion (DLI) 2 and 4 months post allo-BMT, The influence of these factors on development of VZV virus infection is discussed, We also highlight the high incidence and high morta lity in VZV infection in immunocompromised patients as well as the frequent atypical presentation.