Varicella-Zoster Virus-associated Fulminant Hepatitis Following Allogeneic Hematopoietic Stem Cell Transplantation for Multiple Myeloma

Abstract Disseminatedvisceralvaricella-zostervirus(VZV)infectionrarelyoccursinrecipientsofallogeneichema-topoieticstemcelltransplantation(allo-HSCT).Todate,onlyafewcasesofisolatedVZV-inducedfulminanthepatitis following allo-HSCT have been reported. We herein describe the case of a 47-year-old Japaneseman with multiple myeloma who developed fulminant hepatitis 17 months after undergoing allo-HSCT. De-spitereceivingfreshfrozenplasmaandplatelettransfusions,hedevelopedableedingtendency(systemicpur-pura,petechiaeandoralbleeding),slippedintoacomaandeventuallydied.Hewasretrospectivelydiagnosedwith viscerally disseminated VZV infection based on a postmortem examination and multiplex polymerasechainreaction(PCR)amplification. Key words: varicella-zostervirus,fulminanthepatitis,allogeneichematopoieticstemcelltransplantation (Intern Med 52: 1727-1730, 2013)(DOI: 10.2169/internalmedicine.52.0118) Introduction Varicella-zoster virus (VZV) reactivation is a frequentlyobserved opportunistic infection that develops after alloge-neic hematopoietic stem cell transplantation (allo-HSCT),with a high incidence of 30-50%(1,2). However, dissemi-natedvisceralVZVinfection,presentingwithileus,abdomi-nal pain, hepatitis or meningoencephalitis, rarely occurs inrecipients of allo-HSCT(3-14). To the best of our knowl-edge, only a few cases of isolated VZV-induced fulminanthepatitis following allo-HSCT have been reported todate(15-17).Wehereinreporttheclinicalcourseofanallo-HSCTpatientwithmultiplemyelomawhodevelopedfulmi-nant hepatitis 17 months after undergoing allo-HSCT andwas diagnosed with viscerally disseminated VZV infectiononapostmortemexamination.