Severe hepatitis associated with varicella zoster virus infection in a patient with diffuse large B cell lymphoma treated with rituximab-CHOP chemotherapy

• Published in: International journal of hematology Vol. 96; no. 4; pp. 516 - 520
• Main Authors: Okamoto, Akinao, Abe, Akihiro, Okamoto, Masataka, Kobayashi, Tsukane, Terazawa, Tomohiko, Inaguma, Yoko, Tokuda, Masutaka, Yanada, Masamitsu, Morishima, Satoko, Kanie, Tadaharu, Yamamoto, Yukiya, Tsuzuki, Motohiro, Akatsuka, Yoshiki, Mizuta, Shuichi, Yoshikawa, Tetsushi, Emi, Nobuhiko
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01-10-2012; Springer; Springer Nature B.V
• Subjects: Acyclovir; Aged, 80 and over; Antibodies, Monoclonal, Murine-Derived - adverse effects; Antibodies, Monoclonal, Murine-Derived - therapeutic use; Antibodies, Viral - blood; Antibodies, Viral - immunology; Antineoplastic Combined Chemotherapy Protocols - adverse effects; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; B-cell lymphoma; Beta cells; Biological and medical sciences; Case Report; Chemotherapy; Cyclophosphamide; Cyclophosphamide - adverse effects; Cyclophosphamide - therapeutic use; Diabetes mellitus; Doxorubicin; Doxorubicin - adverse effects; Doxorubicin - therapeutic use; Gastroenterology. Liver. Pancreas. Abdomen; Geriatrics; Health risks; Hematologic and hematopoietic diseases; Hematology; Hematopoietic stem cells; Hemopoiesis; Hepatitis; Hepatitis - diagnosis; Hepatitis - etiology; Herpes Zoster - diagnosis; Herpes Zoster - etiology; Herpesvirus 3, Human - immunology; Humans; Immunoglobulin G; Infection; Infections; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Lymphoma; Lymphoma, Large B-Cell, Diffuse - drug therapy; Lymphopenia; Male; Medical sciences; Medicine; Medicine & Public Health; Oncology; Other diseases. Semiology; Patients; Platelet diseases and coagulopathies; Prednisolone; Prednisone - adverse effects; Prednisone - therapeutic use; Rituximab; Stem cell transplantation; Stem cells; thrombomodulin; Transplantation; Varicella; Varicella-zoster virus; Vincristine; Vincristine - adverse effects; Vincristine - therapeutic use; Viruses; Varicella zoster virus; Rituximab; Hepatitis; Disseminated intravascular coagulopathy; Antineoplastic agent; Alphaherpesvirinae; Hepatic disease; Monoclonal antibody; CHOP protocol; Lymphoproliferative syndrome; Immunotherapy; Human; Hematology; Herpesviridae; B cell neoplasm; Malignant hemopathy; Non Hodgkin lymphoma; Virus; Infection; Associated virus; Treatment; Digestive diseases; Diffuse large B cell lymphoma; Coagulopathy; Cancer
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-012-1160-4

Severe disseminated varicella zoster virus (VZV) infection rarely occurs in patients who are not recipients of hematopoietic stem cell transplantation. This report concerns severe disseminated VZV infection in a diffuse large B cell lymphoma (DLBCL) patient treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The patient was an 82-year-old male with DLBCL who had a history of type II diabetes mellitus. He incurred VZV infection with severe hepatitis and disseminated intravascular coagulopathy after three courses of R-CHOP. When the VZV infection occurred, anti-VZV IgG was not detected and lymphopenia was observed. We initiated treatment with acyclovir, immunoglobulin, and thrombomodulin alpha, and rescued this patient. We suggest that the use of chemotherapy for immune-suppressed elderly lymphoma patients may involve the risk of severe VZV infection.