valacyclovir and Breast-Neoplasms

Disseminated herpes zoster is defined as the presence of more than 20 lesions outside the dermatome. This unusual presentation is more common in immunosuppressed patients. Complications such as hepatitis, encephalitis, and pneumonitis are more likely in individuals with disseminated varicella zoster virus infection.A 63-year-old woman being treated for breast cancer developed multiple pustules and vesicles days after starting doxorubicin and cyclophosphamide chemotherapy. Ten individual lesions appeared on her chest, abdomen, back, and leg. Non-dermatomal disseminated herpes zoster was suspected. She was treated with oral antiviral therapy, as well as with oral and topical antibiotics. Varicella zoster virus infection was confirmed by direct fluorescent antibody staining. After one month, her skin lesions had resolved and she resumed chemotherapy.In a setting of immunosuppression, the rare presentation of disseminated herpes zoster without dermatome should be considered. Appropriate antiviral therapy should be administered while waiting for confirmation of the diagnosis, so as to reduce the risk of visceral dissemination of the varicella zoster virus infection.

Topics: Acyclovir; Antiviral Agents; Breast Neoplasms; Female; Herpes Zoster; Humans; Immunocompromised Host; Middle Aged; Valacyclovir; Valine

Herpes zoster, commonly called shingles, is a disease that results from the reactivation of varicella zoster virus. Local trauma has been reported as a precipitant for reactivation, but this condition is rarely seen localized to a fresh surgical incision. We present the case of a patient who developed shingles overlying the incision site of a recently buried central venous access port, illustrating the need to consider this diagnosis as a unique imposter of localized infection or reaction at sites of recent procedural trauma.

Topics: Acyclovir; Adult; Antineoplastic Combined Chemotherapy Protocols; Breast Neoplasms; Catheter-Related Infections; Central Venous Catheters; Female; Follow-Up Studies; Herpes Zoster; Herpesvirus 3, Human; Humans; Treatment Outcome; Valacyclovir; Valine

The number needed to treat (NNT) is a simple measure of a treatment's impact, increasingly reported in randomized trials and observational studies. Its calculation in studies involving varying follow-up times or recurrent outcomes has been criticized. We discuss the NNT in these contexts, illustrating using several published studies. The computation of the NNT is founded on the cumulative incidence of the outcome. Instead, several published studies use simple proportions that do not account for varying follow-up times, or use incidence rates per person-time. We show that these approaches can lead to erroneous values of the NNT and misleading interpretations. For example, after converting the incidence rate to a cumulative incidence, we show that a trial reporting a NNT of 4 "to prevent one exacerbation in 1 year" should have reported a NNT of 9. A survey of all papers reporting NNT, published in four major medical journals in 2009, found that 6 out of all 10 papers involving varying follow-up times did not correctly estimate the NNT. As the "number needed to treat" becomes increasingly used in complex studies and in the comparative effectiveness of therapies, its accurate estimation and interpretation become crucial to avoid erroneous clinical and public health decisions.

Topics: Acyclovir; Antineoplastic Agents; Antiviral Agents; Breast Neoplasms; Data Interpretation, Statistical; Diphosphonates; Evidence-Based Medicine; Female; Follow-Up Studies; Herpes Simplex; Humans; Imidazoles; Kaplan-Meier Estimate; Life Tables; Periodicals as Topic; Randomized Controlled Trials as Topic; Research Design; Risk Assessment; Risk Factors; Sample Size; Survival Rate; Time Factors; Valacyclovir; Valine; Zoledronic Acid