Varicella vaccine meningoencephalitis in a child receiving autologous bone marrow transplantation

Abstract

AbstractBackgroundVaricella vaccine, a live‐attenuated Oka‐strain of varicella zoster virus (VZV), is a recommended childhood vaccine by many countries. As with wild varicella strain, after primary infection, the live‐attenuated virus can establish latency in sensory ganglia and reactivate causing vaccine‐strain illnesses: herpes zoster (HZ), visceral or peripheral and central nervous system dissemination. We report a case of early reactivation of live‐attenuated virus—HZ and meningoencephalitis—in an immunocompromised child.MethodsThis is a retrospective descriptive report of a case, in a tertiary pediatric hospital, CHU Sainte‐Justine (Montréal, Canada).ResultsAn 18 month‐year old girl diagnosed with a primitive neuro‐ectodermal tumor (PNET) received the day prior to diagnosis, a first varicella vaccine (MMRV). She received chemotherapy 20 days post MMRV vaccine and autologous bone marrow transplantation 3 months post vaccination. She was considered not eligible, to acyclovir prophylaxis prior transplantation (positive for VZV IgG and negative for herpes simplex virus IgG by ELISA). At day 1 post transplantation, she developed dermatomal HZ and meningoencephalitis. Oka‐strain varicella was isolated, she was treated with acyclovir and foscarnet. Neurologic status improved in 5 days. Control of VZV viral load in cerebrospinal fluid showed a slow decrease to from 5.24 log 10 copies/mL to 2.14 log 10 copies/mL in 6 weeks. No relapse was observed. She recovered without neurological sequelae.ConclusionsOur experience highlights the importance of conducting a thorough medical history regarding vaccination and serological status of newly immunocompromised patients. Intensive chemotherapy succeeding live vaccine administration <4 weeks could have influenced early and severe viral reactivation. Early initiation of prophylactic antiviral treatment is questioned in such circumstances.