Tauro S, Toh V, Osman H, Mahendra P
Bone Marrow Transplant Unit, University Hospital Birmingham NHS Trust, Birmingham, UK.
Bone Marrow Transplant. 2000 Oct;26(7):795-6. doi: 10.1038/sj.bmt.1702599.
Herpes zoster infections are frequently observed after allogeneic bone marrow transplantation (alloBMT). In the majority of cases, the infection is restricted to specific dermatomes and responds to oral acyclovir, without visceral dissemination. We report the case of a 40-year-old male who developed dermatomal herpetic infection 8 months post alloBMT. The herpetic rash responded well to treatment with high-dose oral acyclovir. However, within a week of cessation of therapy, the patient re-presented with dermatomal zoster and meningoencephalitis. Although the cutaneous lesions resolved with intravenous acyclovir, clinical features of meningoencephalitis persisted, along with evidence of varicella zoster virus (VZV) DNA in cerebrospinal fluid (CSF). A satisfactory response to treatment was observed only after the addition of intravenous foscarnet to acyclovir. Based on our experience with this patient, we suggest that in a subset of alloBMT recipients, late dermatomal herpes zoster infections may respond only partially to treatment with standard oral acyclovir. The use of oral acyclovir preparations with higher bioavailability (valacyclovir) or intravenous acyclovir early on may prevent the considerable morbidity associated with disseminated zoster infection. Bone Marrow Transplantation (2000) 26, 795-796.
在异基因骨髓移植（alloBMT）后，带状疱疹感染较为常见。在大多数情况下，感染局限于特定皮节，对口服阿昔洛韦有反应，无内脏播散。我们报告一例40岁男性，在alloBMT后8个月发生皮节疱疹感染。疱疹皮疹对高剂量口服阿昔洛韦治疗反应良好。然而，在治疗停止一周内，患者再次出现皮节带状疱疹和脑膜脑炎。虽然皮肤损害经静脉注射阿昔洛韦后消退，但脑膜脑炎的临床特征持续存在，脑脊液（CSF）中也有水痘带状疱疹病毒（VZV）DNA的证据。仅在阿昔洛韦基础上加用静脉注射膦甲酸钠后才观察到满意的治疗反应。基于我们对该患者的经验，我们建议在一部分alloBMT受者中，晚期皮节带状疱疹感染对标准口服阿昔洛韦治疗可能仅部分有效。早期使用生物利用度更高的口服阿昔洛韦制剂（伐昔洛韦）或静脉注射阿昔洛韦，可能预防与播散性带状疱疹感染相关的严重发病情况。《骨髓移植》（2000年）26卷，795 - 796页
