SAN FRANCISCO — Suspect chronic varicella zoster in all immunocompromised children, not just those with HIV, Dr. Christopher Bohyer said at the annual meeting of the American Academy of Dermatology.
Test zosterlike lesions in immunocompromised children for drug resistance, because chronic varicella typically implies antibiotic resistance, said Dr. Bohyer of Indiana University, Bloomington.
He presented what may be the first case of chronic varicella zoster in a child after bone marrow transplant. Other cases have been reported in children who have undergone chemotherapy or who have HIV.
Dr. Bohyer's patient was an 11-year-old boy who was diagnosed in 2003 with acute myelogenous leukemia and was treated with chemotherapy. He relapsed in April 2004, underwent donor stem cell transplant, and developed acute graft-versus-host disease.
He was out of the hospital in September 2004, when he developed significant abdominal pain. Clinicians feared this was a worsening of his graft-versus-host disease, but a GI work-up that included an intestinal biopsy showed no findings consistent with that diagnosis.
Three days after admission, he had an eruption of multiple vesicles on his head and neck. Culture identified them as varicella zoster infection, and he was treated with high-dose IV acyclovir 10 mg/kg for 15 days.
The patient went home and was doing well until a month later when he was readmitted with another unusual cutaneous eruption on his whole body.
The vesicles and papules housed varicella zoster, culture showed.
Another round of high-dose acyclovir stemmed the eruption of any new lesions, but the chronic lesions did not resolve.
Around this time the patient's condition deteriorated to the point that support was withdrawn, and he died.