Shimizu Ryo, Ohwada Chikako, Nagao Yuhei, Togasaki Emi, Kawajiri Chika, Muto Tomoya, Tsukamoto Shokichi, Sakai Shio, Takeda Yusuke, Mimura Naoya, Takeuchi Masahiro, Sakaida Emiko, Iseki Tohru, Nakaseko Chiaki
Department of Hematology, Chiba University Hospital, Japan.
Intern Med. 2017;56(3):353-356. doi: 10.2169/internalmedicine.56.6930. Epub 2017 Feb 1.
Infections of the central nervous system (CNS) with varicella zoster virus (VZV) is a rare occurrence after allogeneic hematopoietic stem cell transplantation. We herein report a case of VZV meningitis, radiculitis and myelitis that developed 8 months after cord blood transplantation, shortly after the cessation of cyclosporine and low-dose acyclovir. Although treatment with acyclovir did not achieve a satisfactory response, the patient was successfully treated with foscarnet. Our report indicates that VZV infection should be considered in allo-hematopoietic stem cell transplantation (HSCT) patients with CNS symptoms and that foscarnet may be effective for the treatment of acyclovir-resistant VZV infections of the CNS. The development of optimal prophylactic strategies and vaccination schedules may eradicate post-transplant VZV disease.
异基因造血干细胞移植后，水痘带状疱疹病毒（VZV）感染中枢神经系统（CNS）的情况较为罕见。我们在此报告1例脐血移植8个月后发生的VZV脑膜炎、神经根炎和脊髓炎病例，该病例发生于停用环孢素和小剂量阿昔洛韦后不久。尽管阿昔洛韦治疗未取得满意疗效，但患者使用膦甲酸钠治疗成功。我们的报告表明，对于出现中枢神经系统症状的异基因造血干细胞移植（HSCT）患者应考虑VZV感染，且膦甲酸钠可能对治疗阿昔洛韦耐药的中枢神经系统VZV感染有效。制定最佳预防策略和疫苗接种计划可能会根除移植后VZV疾病。
