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, who underwent donor stem cell transplant as treatment for acute myelogenous leukemia, and developed acute graft-versus-host disease. After the boy left the hospital, in September 2004 he developed abdominal pain. An eruption on his head and neck was identified as varicella zoster infection, and he was treated with high-dose IV acyclovir.
The patient went home but 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. At this time the patient's condition deteriorated so much that support was withdrawn, and he died.