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Severe abdominal pain and inappropriate antidiuretic hormone secretion preceding varicella-zoster virus reactivation 10 months after autologous stem cell transplantation for acute myeloid leukaemia

Bone Marrow Transplantation volume 35, pages 525–527 (2005)Cite this article

We report a rare presentation of varicella-zoster virus (VZV) infection, in which severe abdominal pain associated with inappropriate antidiuretic hormone secretion (SIADH) preceded the classic vesicular rash of VZV infection by several days in an autologous stem cell transplant (SCT) recipient. In view of this atypical presentation of VZV reactivation in an immunocompromised host, early diagnostic tests are useful, and moreover, prompt, empirical antiviral therapy is needed to avoid possible life-threatening complications.

VZV reactivation is a common complication after allogeneic and autologous SCT. Its incidence was evaluated as 18.6% in a recent review of autologous SCT and occurred mostly within the 6 months post-SCT.1 Rarely, unusual manifestations may precede the classic zoster eruption and delay diagnosis and effective antiviral therapy. Among these atypical initial presentations, the combined pattern of abdominal pain and hyponatraemia has been reported in five patients after one autologous2 and four allogeneic SCT.3,4,5 We report a further case of a VZV reactivation presenting in this atypical manner in an autologous SCT recipient.

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References

  1. Bilgrami S, Chakraborty NG, Rodriguez-Pinero F et al. Varicella zoster virus infection associated with high-dose chemotherapy and autologous stem-cell rescue. Bone Marrow Transplant 1999; 23: 469–474.

    Article  CAS  Google Scholar 

  2. McIlwaine LM, Fitzsimons EJ, Soutar RL . Inappropriate antidiuretic hormone secretion, abdominal pain and disseminated varicella-zoster virus infection: an unusual and fatal triad in a patient 13 months post Rituximab and autologous stem cell transplantation. Clin Lab Haematol 2001; 23: 253–254.

    Article  CAS  Google Scholar 

  3. Au WY, Ma SY, Cheng VC et al. Disseminated zoster, hyponatraemia, severe abdominal pain and leukaemia relapse: recognition of a new clinical quartet after bone marrow transplantation. Br J Dermatol 2003; 149: 862–865.

    Article  CAS  Google Scholar 

  4. Szabo F, Horvath N, Seimon S, Hughes T . 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. Bone Marrow Transplant 2000; 26: 231–233.

    Article  CAS  Google Scholar 

  5. Drakos P, Weinberger M, Delukina M et al. Inappropriate antidiuretic hormone secretion (SIADH) preceding skin manifestations of disseminated varicella zoster virus infection post-BMT. Bone Marrow Transplant 1993; 11: 407–408.

    CAS  Google Scholar 

  6. David DS, Tegtmeier BR, O'Donnell MR et al. Visceral varicella-zoster after bone marrow transplantation: report of a case series and review of the literature. Am J Gastroenterol 1998; 93: 810–813.

    Article  CAS  Google Scholar 

  7. de Jong MD, Weel JF, van Oers MH et al. Molecular diagnosis of visceral herpes zoster. Lancet 2001; 357: 2101–2102.

    Article  CAS  Google Scholar 

  8. Stratman E . Visceral zoster as the presenting feature of disseminated herpes zoster. J Am Acad Dermatol 2002; 46: 771–774.

    Article  Google Scholar 

  9. Ingraham Jr IE, Estes NA, Bern MM, DeGirolami PC . Disseminated varicella-zoster virus infection with the syndrome of inappropriate antidiuretic hormone. Arch Intern Med 1983; 143: 1270–1271.

    Article  Google Scholar 

  10. Sato TL, Jones JS, McGrail MA, MacLean DB . Herpes zoster infection of the chest wall and the syndrome of inappropriate antidiuretic hormone secretion. S Med J 1990; 83: 247–249.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Service de Médecine interneet Nutrition, Centre Hospitalier Universitaire de Hautepierre, Strasbourg, France

    S Vinzio, I Enescu, J L Schlienger & B Goichot

  2. Département d'Oncologie et d'Hématologie, Centre Hospitalier Universitaire de Hautepierre, Strasbourg, France

    B Lioure

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  1. S Vinzio
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  2. B Lioure
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  4. J L Schlienger
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Vinzio, S., Lioure, B., Enescu, I. et al. Severe abdominal pain and inappropriate antidiuretic hormone secretion preceding varicella-zoster virus reactivation 10 months after autologous stem cell transplantation for acute myeloid leukaemia. Bone Marrow Transplant 35, 525–527 (2005). https://doi.org/10.1038/sj.bmt.1704814

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