Kronik Lenfositik Lösemide Kullanılan Fludarabin Tedavisinden Sonra Gelişen Atipik Herpes Zoster (Zona) Enfeksiyonu: Olgu Sunumu

Öz

Herpes zoster (zona), varisella zoster virüsünün neden olduğu akut veziküler erüpsiyon ile seyreden bir infeksiyondur. Dermatomal dağılımla sınırlı, tek taraflı ve ağrılı döküntülerle karakterizedir. 49 yaşında, Kafkasyalı, erkek hastada kronik lenfositik lösemi nedeni ile fludarabin tedavisi alırken karının sağ tarafında ağrılı veziküller oluştu. Nötropenik olan hastaya anamnez ve izik muayene ile zona tanısı kondu ve asiklovir tedavisi başlandı. Tedavinin 3. gününde hastanın yüz ve kafa derisi dahil tüm vücüdunda yaygın eritematöz veziküller gelişti. Tzanck testi ile varisella zoster olduğu gösterildi. Asiklovir tedavisine rağmen hastanın akciğerinde diffüz infiltrasyon izlendi, hipertermi ve dispne meydana geldi. Toraks tomoğrafisi pnömoni ile uyumlu idi. Hastanın hipertermisi teikoplanin, meronepem ve intravenöz immünglobuline cevap vermedi. Hasta öldü. Anahtar kelimeler: Herpes Zoster; Zona; Infeksiyon; Fludarabin; Kronik Lenfositik Lösemi.

Anahtar Kelimeler

• Herpes Zoster; Zona; Infeksiyon; Fludarabin; Kronik Lenfositik Lösemi.

Atypical Presentation of Herpes Zoster Infection Following Fludarabine Treatment for Chronic Lymphocytic Leukemia: A Case Report

Abstract

Herpes zoster (zona) is an infection with acute vesicular eruption due to the varicella zoster virus. A painful skin rash characterizes herpes zoster, with dermatomal distribution in a limited area on one side of the body. A 49-year-old Caucasian male with chronic lymphocytic leukemia presented with sudden onset of painful vesicles on the right abdomen. He was receiving fludarabine for the treatment of Chronic lymphocytic leukemia. The patient was neutropenic and diagnosed as zona zoster based on history and physical examination; acyclovir treatment was initiated. After 3 days of the treatment he developed florid disseminated erythematous vesicles over his entire body, including the face and scalp. Tzanck smear showed varicella zoster. Despite acyclovir treatment diffuse infiltration was observed in the lungs of the patient, with hyperthermia and dyspnea. Pneumonia was consisted with thoracic computed tomography. The patient's hyperthermia did not respond to teikoplanin, meropenem and intravenous immunoglobulin. He died. Key words: Herpes Zoster; Zona; Infection; Fludarabine; Chronic Lymphocytic Leukemia.

Keywords

• Herpes Zoster; Zona; Infection; Fludarabine; Chronic Lymphocytic Leukemia.

References

1. Whitley R. Varcella-zoster virus. In: Mandell GL, Bennett JE, Dolin R. Principles and Practice of Infectious Diseases. 6th edition. Elsevier Churchill Livingstone 2005; 2: 1780-6.
2. Levy O, Orange JS, Hibberd P, et al. Disseminated varicella infection due to the vaccine strain of varicella-zoster virus in a patient with a novel deficiency in natural killer T cells. J Infect Dis 2003; 188: 948-53.
3. Byrd JC, McGrail LH, Hospenthal DR, et al. Herpesvirus infections occur frequently following treatment with fludarabine: results of a prospective natural history study. Br J Haematol ; 105: 445-7. Ghia P, Scielzo C, Frenquelli M, et al. From normal to clonal B cells: chronic lymphocytic leukemia (CLL) at the crossroad between neoplasia and autoimmunity. Autoimmun Rev 2007; 7: 31.
4. Atypical Presentation of Herpes Zoster Infection Following Fludarabine Treatment for Chronic Lymphocytic Leukemia: A Case Report Scrivener S, Goddard RV, Kaminski ER, et al. Abnormal T-cell function in B-cell chronic lymphocytic leukaemia. Leuk Lymphoma 2003; 44: 383-9.
5. Corresponding Author: Mehmet Ali Erkurt, MD Department of Hematology, School of Medicine Turgut Özal Medical Center, Inonu University MALATYA Tel.: [phone], Fax: [phone] e-mail [e-mail]