Varicella-zoster virus infection after bone marrow transplantation: unusual presentations and prophylaxis

BACKGROUND: Leukemaia and lymphoproliferative disease are associated with a high risk of varicela-zoster virus (VZV) infection. Although infrequent vi sceral 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 allog eneic bone marrow transplantation for chronic myelogenous leukemia. A sever e graft-versus-host reaction occurred. Three months after discontinuing VZV prophylaxis, VZV transverse myelitis was diagnosed, leading to death despi te prompt treatment with acyclovir. The second patient was a 42-year-old wo man treated with autologous bone marrow transplantation for lymphoma. She d eveloped acute viral pancreatitis one month after discontinuing VZV prophyl axis. Recovery was achieved with intravenous treatment. DISCUSSION: These two cases illustrate the potential gravity of VZV infecti on after bone marrow transplantation. These observations point to the need for revisiting the duration of VZV prophylaxis.