International Journal of Hematology

, Volume 96, Issue 4, pp 516–520 | Cite as

Severe hepatitis associated with varicella zoster virus infection in a patient with diffuse large B cell lymphoma treated with rituximab-CHOP chemotherapy

  • Akinao Okamoto
  • Akihiro Abe
  • Masataka Okamoto
  • Tsukane Kobayashi
  • Tomohiko Terazawa
  • Yoko Inaguma
  • Masutaka Tokuda
  • Masamitsu Yanada
  • Satoko Morishima
  • Tadaharu Kanie
  • Yukiya Yamamoto
  • Motohiro Tsuzuki
  • Yoshiki Akatsuka
  • Shuichi Mizuta
  • Tetsushi Yoshikawa
  • Nobuhiko Emi
Case Report

Abstract

Severe disseminated varicella zoster virus (VZV) infection rarely occurs in patients who are not recipients of hematopoietic stem cell transplantation. This report concerns severe disseminated VZV infection in a diffuse large B cell lymphoma (DLBCL) patient treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). The patient was an 82-year-old male with DLBCL who had a history of type II diabetes mellitus. He incurred VZV infection with severe hepatitis and disseminated intravascular coagulopathy after three courses of R-CHOP. When the VZV infection occurred, anti-VZV IgG was not detected and lymphopenia was observed. We initiated treatment with acyclovir, immunoglobulin, and thrombomodulin alpha, and rescued this patient. We suggest that the use of chemotherapy for immune-suppressed elderly lymphoma patients may involve the risk of severe VZV infection.

Keywords

Varicella zoster virus Rituximab Hepatitis Disseminated intravascular coagulopathy 

Notes

Acknowledgments

This work was supported by a grant-in-aid from Fujita Health University. We sincerely thank Akiko Yoshikawa, Sachiko Tsuzuki, and Akemi Endo for their valuable laboratory assistance.

Conflict of interest

The authors have no conflict of interest.

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Copyright information

© The Japanese Society of Hematology 2012

Authors and Affiliations

  • Akinao Okamoto
    • 1
  • Akihiro Abe
    • 1
  • Masataka Okamoto
    • 1
  • Tsukane Kobayashi
    • 2
  • Tomohiko Terazawa
    • 3
  • Yoko Inaguma
    • 1
  • Masutaka Tokuda
    • 1
  • Masamitsu Yanada
    • 1
  • Satoko Morishima
    • 1
  • Tadaharu Kanie
    • 1
  • Yukiya Yamamoto
    • 1
  • Motohiro Tsuzuki
    • 1
  • Yoshiki Akatsuka
    • 1
  • Shuichi Mizuta
    • 1
  • Tetsushi Yoshikawa
    • 4
  • Nobuhiko Emi
    • 1
  1. 1.Department of Hematology and Medical OncologyFujita Health University School of MedicineToyoakeJapan
  2. 2.Department of DermatologyFujita Health University School of MedicineToyoakeJapan
  3. 3.Department of PharmacyFujita Health University School of MedicineToyoakeJapan
  4. 4.Department of PediatricsFujita Health University School of MedicineToyoakeJapan

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