acyclovir and Lymphoma--Non-Hodgkin

Varicella-zoster virus (VZV) encephalitis in the absence of vasculopathy may rarely occur in association with herpes zoster. We herein report the case of a 67-year-old woman with non-Hodgkin's lymphoma undergoing chemotherapy who presented with an acute alteration in consciousness. Magnetic resonance imaging of the brain revealed multiple and nonspecific lesions of hyperintensity with mild edema in the cortex and subcortex. She was treated with intravenous acyclovir. However, two days after admission, the patient died and was diagnosed with VZV encephalitis. This case highlights the risk of VZV reactivation with severe neurological complications in patients undergoing immunosuppressive therapy.

Topics: Acyclovir; Aged; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Autopsy; Brain; Cyclophosphamide; Doxorubicin; Encephalitis, Varicella Zoster; Female; Herpesvirus 3, Human; Humans; Lymphoma, Non-Hodgkin; Magnetic Resonance Imaging; Prednisone; Rituximab; Vincristine

To present an unusual cause of bilateral sensorineural hearing loss mimicking chemotherapy-induced ototoxicity.. A 76-year-old woman with bilateral sudden sensorineural hearing loss after chemotherapy for non-Hodgkin lymphoma was referred for cochlear implantation.. Prednisone and acyclovir were administered empirically during the course of the diagnostic evaluation.. Diagnostic tests were obtained, including audiometry, positron emission tomography/computed tomographic imaging, and magnetic resonance imaging scan of the brain with gadolinium.. Audiometry revealed bilateral profound sensorineural hearing loss without improvement after steroid and acyclovir treatment. Postchemotherapy positron emission tomography/computed tomographic imaging obtained 1 week after onset of hearing loss suggested the lymphoma to be in remission. However, magnetic resonance imaging obtained a few weeks later, concurrent with progression of symptoms to include facial palsy and numbness, demonstrated enhancement and thickening of multiple cranial nerves, consistent with neurolymphomatosis (malignant lymphocytic infiltration of nerves).. Particular vigilance must be given to the potential for malignant invasion of the peripheral nervous system in the context of new-onset sensorineural hearing loss after chemotherapy. Such a neurologic deficit should not be assumed to be chemotherapy induced even if the hearing loss is bilaterally symmetric and the only neurologic abnormality.

Topics: Acyclovir; Aged; Anti-Inflammatory Agents; Antineoplastic Agents; Antiviral Agents; Audiometry; Cranial Nerves; Diagnosis, Differential; Female; Hearing Loss, Bilateral; Humans; Lymphoma, Non-Hodgkin; Magnetic Resonance Imaging; Peripheral Nervous System Neoplasms; Prednisone

Post-transplant non-Hodgkin lymphoma is a feared complication of immunosuppressive treatment and is associated with high mortality. Most post-transplant lymphomas develop from the uncontrolled proliferation of Epstein-Barr-virus (EBV)-infected B lymphocytes. No reliable methods for the prevention of EBV infection and lymphoma are available. We aimed to elucidate the effect of prophylactic treatment for cytomegalovirus (CMV) infection on the incidence of post-transplant lymphomas.. In a multicentre retrospective study, we analysed the incidence of post-transplant non-Hodgkin lymphoma in 44 828 recipients of deceased-donor kidney transplants who were reported to the scientific registry of the Collaborative Transplant Study. Patients had received antiviral drugs (aciclovir or ganciclovir) or anti-CMV immunoglobulin to prevent CMV infection according to the transplant centres' protocols, or no CMV prophylaxis. Standardised incidence ratios (SIR) of lymphoma were calculated and compared by chi(2) analyses. During the first post-transplantation year, 30 255 patients who did not receive CMV prophylaxis developed lymphomas at SIR 26.4. Lymphoma incidence in 12 470 patients who received antiviral treatment was nearly identical (SIR 24.2, p=0.62) to that in patients who did not receive CMV prophylaxis. However, 2103 patients who received anti-CMV immunoglobulin showed a complete absence of lymphomas in the first after-transplantation year (SIR 0; p=0.012 vs no treatment, p=0.016 vs antivirals). In the subsequent 5 years of follow-up, new cases of lymphoma developed at similar rates in all three groups (p=0.97).. These findings suggest that prophylactic anti-CMV immunoglobulin prevents the development of early post-transplant non-Hodgkin lymphoma in kidney-graft recipients. Prophylactic treatment with antiviral drugs does not reduce the risk of post-transplant lymphoma.

Topics: Acyclovir; Adolescent; Adult; Aged; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunoglobulins; Incidence; Kidney Transplantation; Lymphoma, Non-Hodgkin; Male; Middle Aged; Retrospective Studies

We report on a 54-year-old male patient with an aggressive T cell non-Hodgkin's lymphoma with abdominal manifestation undergoing autologous peripheral blood stem cell transplantation after high-dose chemotherapy in April 2003. About 4 months after transplantation, he developed severe upper abdominal pain. Ultrasound examination, X-ray, computed tomography of the abdomen and cardiac diagnostics could not explain the symptoms. While empiric therapy with high-dose acyclovir was started, we could document herpetic lesions in the gastric antrum by endoscopy. The epigastric pain rapidly decreased within several days after the start of acyclovir therapy. No herpetic skin lesions were observed at any time during the disease. This report demonstrates the importance of viral-induced gastritis in the differential diagnosis of severe abdominal pain in patients receiving autologous peripheral blood stem cell transplantation.

Topics: Abdomen, Acute; Acyclovir; Antiviral Agents; Diagnosis, Differential; Gastritis; Gastroscopy; Herpes Zoster; Herpesvirus 3, Human; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Peripheral Blood Stem Cell Transplantation; Pyloric Antrum; Transplantation, Autologous

Visceral disseminated varicella-zoster virus (VZV) infection occurred with acute graft-versus-host disease in a 33-year-old Japanese male with non-Hodgkin lymphoma who had undergone allogeneic stem cell transplantation from an HLA-identical sibling after reduced intensity conditioning chemotherapy. Although ganciclovir and acyclovir treatment was effective temporarily, the number of VZV-DNA copies in the blood remained at a high level, and the hepatitis was prolonged. The patient was treated with foscarnet, which led to improvement of the VZV viremia and the hepatic dysfunction. Foscarnet therapy should be considered for acyclovir-resistant VZV infection in the setting of allogeneic hematopoietic stem cell transplantation.

Topics: Acyclovir; Adult; Antiviral Agents; Central Nervous System Neoplasms; Drug Resistance, Viral; Foscarnet; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Lymphoma, Non-Hodgkin; Male; Recurrence; Transplantation, Homologous

The conditioning regimen preceding hematopoietic stem cell transplantation (HSCT) causes a rapid decrease in the platelet count and signs of disseminated intravascular coagulation, possibly indicating platelet activation. As impacts during the conditioning regimen may predict later transplantation-associated complications, we investigated changes in platelet membrane glycoproteins (GP) and the liberation of microparticles. Platelet receptors and granules of 49 patients undergoing HSCT were evaluated by flow cytometric analysis before and after the different phases of the conditioning regimen [chemotherapy, total body irradiation (TBI), therapy with antithymocyte globulin (ATG)] and final transplantation. Following chemotherapy a high surface expression of CD62P, a low mepacrine staining, and a reduced surface expression of CD42b (part of the GP Ib/V/IX complex) were found, indicating an irreversible activation of platelets. In addition, elevated levels of circulating microparticles were observed, which may reinforce the thrombosis risk in these patients. Treatment with ATG leads to an elevated surface expression of PAC-1 epitopes, which are neoepitopes appearing after activation of GP IIb/IIIa. However, a significant degranulation was not detectable, which may be the consequence of inhibitory influences on platelets during ATG-induced cytokine release syndrome. TBI and transplantation itself had no influence on platelets. This study was able to demonstrate activating effects on platelets by certain phases of the conditioning regimen in patients receiving HSCT. Chemotherapy, in particular, leads to a strong and irreversible platelet activation and a generation of microparticles, which may cause an increased thrombosis risk. Our findings underline the impact of platelets on the pathogenesis of hemostatic complications during HSCT.

Topics: Acyclovir; Adult; Aged; Anemia, Aplastic; Antigens, CD; Antiviral Agents; Blood Platelets; Female; Flow Cytometry; Hematopoietic Stem Cell Mobilization; Humans; Leukemia; Lymphoma, Non-Hodgkin; Male; Middle Aged; Myelodysplastic Syndromes; Platelet Count; Platelet Membrane Glycoproteins; Primary Myelofibrosis; Ranitidine; Receptors, Cell Surface; Stem Cell Transplantation; Transplantation, Homologous

Visceral dissemination of herpes zoster may follow cutaneous dissemination in immunocompromised patients. The skin is not necessarily the only organ affected and may not even be the presenting organ. Immunohistochemical stains available for routine paraffin-embedded tissue biopsy specimens allow for rapid diagnosis of varicella zoster virus. We describe a patient in whom gastric dissemination of herpes zoster was proven by immunohistochemistry. Unexplained hepatitis, pancreatitis, gastritis, or complaints of abdominal pain in immunocompromised patients with herpes zoster should prompt a high degree of suspicion for visceral zoster and immediate treatment with intravenous acyclovir.

Topics: Acyclovir; Aged; Biopsy, Needle; Follow-Up Studies; Gastric Mucosa; Gastroscopy; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Immunohistochemistry; Infusions, Intravenous; Lymphoma, Non-Hodgkin; Male; Risk Assessment; Stomach Ulcer; Treatment Outcome

Topics: Acyclovir; Antiviral Agents; Humans; Lymphoma, AIDS-Related; Lymphoma, Non-Hodgkin; Risk

Over an eight-month period from October 1997 to May 1998, four patients who had received bone marrow transplant (BMT) from unrelated donor presented with severe mucosal cutaneous infections involving acyclovir resistant herpes simplex virus 1 (HSV-1). The four isolates were acyclovir (ACV) resistant, three of which were also foscarnet resistant as determined by the dye uptake method. The sequencing of the thymidine kinase (TK) gene did not permit to establish a relation between mutations and resistance to ACV. Three patients were considered as clinically cured of their HSV infection by replacement of ACV or foscarnet with either valacyclovir (one case) or cidofovir (two cases) but eventually two of them died of graft vs host disease. One patient died of extensive HSV infection despite administration of cidofovir. This study emphasizes the importance of monitoring the herpes virus resistance to antiviral drugs in bone marrow transplant recipients and the usefulness of the evaluation of novel antiviral drug for treatment of infections due to strains of HSV resistant to ACV and foscarnet that occur in about 5% of immunocompromised patients.

Topics: Acute Disease; Acyclovir; Adolescent; Amino Acid Substitution; Antiviral Agents; Bone Marrow Transplantation; Child; Cidofovir; Codon; Cytosine; DNA Mutational Analysis; Drug Resistance, Viral; Female; Foscarnet; Graft vs Host Disease; Herpes Simplex; Humans; Immunocompromised Host; Leukemia, Myelogenous, Chronic, BCR-ABL Positive; Leukemia, Myeloid; Lymphoma, Non-Hodgkin; Male; Mutation, Missense; Organophosphonates; Organophosphorus Compounds; Point Mutation; Salvage Therapy; Simplexvirus; Thymidine Kinase; Transplantation, Homologous; Valacyclovir; Valine; Viral Proteins; Virus Activation

A 34-year-old male with a history of chickenpox developed primary abdominal non-Hodgkin's lymphoma (diagnosed in August 1995). Treatment with cyclophosphamide, doxorubicin, vincristine, and prednisolone achieved a partial remission. In July 1996, the disease recurred, and the patient received chemotherapy with carboplatine, etoposide, mitoxantrone, and prednisolone, but no response was noted. Involvement of the central nervous system and meninges was diagnosed on September 12, 1997. Blast cells were detected in the peripheral blood on September 26. Based on these findings, he was diagnosed as having leukemia. On September 27, painless vesicles developed on the left gluteal region. On October 13, the patient was hospitalized because the vesicles had spread over his entire body. Pathologic examination of the roofs of the blisters showed masses of inclusion bodies. Based on this, a diagnosis of varicella-zoster infection was made. Treatment with acyclovir (750 mg/day) for seven days failed to form crusts. New vesicles developed after the drug was discontinued, but crusts formed after acyclovir therapy was resumed. He died of interstitial pneumonia on December 21. Autopsy could not be performed. Histopathologic examination of pulmonary tissue obtained by necropsy did not reveal the presence of inclusion bodies characteristic of herpes simplex or varicella-zoster infection. Varicella-zoster virus (VZV) antigen was negative by an immunochemical staining method using monoclonal antibodies against VZV. Continuous long-term administration of acyclovir has been reported to be effective for non-Hodgkin's lymphoma complicated by recurrent intractable herpes zoster.

Topics: Acyclovir; Adult; Herpes Zoster; Humans; Lymphoma, Non-Hodgkin; Male; Recurrence

Two HIV patients with Epstein-Barr virus (EBV)-associated B cell lymphoma of high grade malignancy enjoyed prolonged remission after therapy with COPBLAM and the antiviral agent Acyclovir. After 3, respectively 5 cycles of treatment, the patients (stage C3 according to CDC) responded to the administered drugs by achieving complete remission. Under maintenance therapy with Acyclovir for 32, respectively 31 months, both patients still remain free of lymphoma as of today.

Topics: Acyclovir; Adult; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Bleomycin; Burkitt Lymphoma; Cyclophosphamide; Doxorubicin; Humans; Lymphoma, AIDS-Related; Lymphoma, Non-Hodgkin; Male; Middle Aged; Prednisone; Procarbazine; Remission Induction; Vincristine

The Second Human Retroviruses Conference covered many topics, including statistics on the viruses' prevalence in American society and some survey results on sexual behavior. Conference meetings were dominated by discussions on protease inhibitors and current clinical trial data on two inhibitors in particular, 3TC and ZDV. Evidence of a new herpes virus causing Kaposi's sarcoma (KS), and research on anti-KS agents, were discussed, including assessments concerning the struggle between the virus and the immune system, and arguments about using immune-based therapies versus attacking the virus directly. Of particular interest concerning immune-based therapy was the National Institute of Allergy and Infectious Diseases' (NIAID) interleukin-2 trial which is showing impressive results in affecting CD4+ counts, if CD4+ counts are not too low initially. Antiretroviral information centered on two investigations surrounding Parke-Davis' PD121871 and PD144975, which seem to prevent activation of latently-infected cells, and return activated cells to a quiescent state. Other conference topics covered acyclovir survival levels, the new therapies and renewed concerns about cytomegalovirus, planning an overall prophylactic strategy, the slow progress in developing a vaccine, and whether low-dose chemotherapy for lymphoma was as good as the standard dose.

Topics: Acyclovir; AIDS Vaccines; AIDS-Related Opportunistic Infections; Antineoplastic Agents; Antiviral Agents; CD4 Lymphocyte Count; Cytomegalovirus Retinitis; Herpesviridae; HIV Infections; Humans; Interleukin-2; Lamivudine; Lymphoma, Non-Hodgkin; Retroviridae; Sarcoma, Kaposi; Zalcitabine; Zidovudine

Topics: Acyclovir; Catheterization, Central Venous; Child; Eye Infections; Humans; Lymphoma, Non-Hodgkin; Male; Pseudomonas Infections

Topics: Acyclovir; Aged; Anecdotes as Topic; Family Practice; Female; Herpes Zoster Oticus; Humans; Leukemia, Hairy Cell; Leukemia, Myeloid, Acute; Lymphoma, Non-Hodgkin; Male; Ondansetron

Reinfection of previously "immune" patients with varicella-zoster virus can result in recurrent chickenpox. However, relapses of chickenpox are not well recognized. We describe a young man with lymphoma who rapidly developed multiple, discrete relapses of chickenpox each time therapy with acyclovir was stopped. His cutaneous infection eventually became unremitting, despite continuous treatment with acyclovir. No evidence ever suggested visceral dissemination of varicella. The patient died suddenly; the cause of death was not determined.

Topics: Acyclovir; Adult; Antineoplastic Combined Chemotherapy Protocols; Chickenpox; Cyclophosphamide; Doxorubicin; Etoposide; Fatal Outcome; Herpesvirus 3, Human; Humans; Immunocompromised Host; Lymphoma, Non-Hodgkin; Male; Mechlorethamine; Methotrexate; Prednisone; Procarbazine; Recurrence; Vincristine; Virus Activation

After undergoing high-dose chemotherapy and autologous bone marrow transplantation, a patient developed fatal disseminated infection due to varicella-zoster virus (VZV) with no coincident skin lesions. This article describes this unusual case and briefly reviews the English-language literature on the abdominal presentation of VZV infection as well as that on VZV infection after bone marrow transplantation. In the severely immunocompromised host, visceral infection with VZV may uncommonly occur in the absence of skin lesions. The possibility of such infection should be considered when immunocompromised patients develop unusual symptoms or other evidence of visceral disease (e.g., cholecystitis).

Topics: Acyclovir; Adult; Bone Marrow Transplantation; Gentamicins; Herpes Zoster; Humans; Immunocompromised Host; Liver; Lymphoma, Non-Hodgkin; Male; Metronidazole; Piperacillin; Transplantation, Autologous

Topics: Acyclovir; Adult; Aged; Aged, 80 and over; Agranulocytosis; Bacterial Infections; Breast Neoplasms; Candidiasis; Female; Herpes Zoster; Hodgkin Disease; Humans; Immunocompromised Host; Lymphoma, Non-Hodgkin; Male; Middle Aged; Neoplasms; Neutropenia

Topics: Acyclovir; Adult; Combined Modality Therapy; Critical Care; Herpes Zoster; Humans; Immunocompromised Host; Lymphoma, Non-Hodgkin; Male; Opportunistic Infections

The aim of this study was to determine the prevalence and type of symptomatic anal and perianal diseases in patients belonging to group IV of the Centers for Disease Control classification of infections with human immuno-deficiency virus. Among the 190 prospectively included patients, 31 (16.3 percent) (30 men, 29 homosexuals or bisexuals; 1 woman) had anal symptoms and were referred for proctological examination. Thirty-five "specific" diagnoses were reached in 25 (13.2 percent) patients: 21 ulcerations, 7 condyloma acuminata, 6 perianal sepsis and 1 non-Hodgkin malignant lymphoma. The causes of ulcerations were 16 herpes, one syphilitic chancre and one fissure-in-ano. Three ulcerations remained unexplained despite bacteriological, viral, and histological investigations. Eight patients underwent 10 surgical procedures without significantly delayed wound healing.

Topics: Acquired Immunodeficiency Syndrome; Acyclovir; Adult; Anus Diseases; Anus Neoplasms; Condylomata Acuminata; Female; Herpes Simplex; Humans; Lymphoma, Non-Hodgkin; Male; Middle Aged; Opportunistic Infections; Prevalence; Prospective Studies; Ulcer

Topics: Abdominal Neoplasms; Acyclovir; Child, Preschool; Female; Heart Transplantation; Humans; Intestinal Neoplasms; Intestine, Small; Lymph Nodes; Lymphoma, B-Cell; Lymphoma, Non-Hodgkin; Neoplasm Invasiveness; Precursor Cell Lymphoblastic Leukemia-Lymphoma

Topics: Acyclovir; Adult; Aged; Breast Neoplasms; Drug Evaluation; Herpesviridae Infections; Hodgkin Disease; Humans; Lymphoma, Non-Hodgkin; Middle Aged

Acyclovir is a new antiviral agent which is active in vitro and in vivo against a variety of herpesviruses. Two cases are reported in which intravenous administration of acyclovir arrested the progress of disseminated herpes zoster within 24 to 48 hours after the beginning of therapy. There was no evidence of toxicity. Thus, acyclovir appears to be useful in the therapy of herpes zoster, but this requires evaluation.

Topics: Acyclovir; Aged; Female; Herpes Zoster; Humans; Leukemia, Lymphoid; Lymphoma, Non-Hodgkin; Middle Aged