Generalized Varicella Zoster infection in a patient with lymphogranulomatosis after bone marrow transplantation: clinical and laboratory characteristics and virus genotyping

A description of a laboratory confirmed clinical case of generalized Varicella Zoster infection in a patient with lymphogranulomatosis after bone marrow transplantation is presented. Detection of the Varicella Zoster virus in biological material was carried out by real-time PCR using the RealBest DNA VZV test system manufactured by Vector-BEST, Russian Federation. Isolation of viral DNA from biological material was performed using the ArtRNA MiniSpin kit (ArtBioTech, Belarus) or QIAamp DNA mini kit (QIAGEN, Germany). The disease had an atypically severe course with a multiorgan lesion, represented not only by lesions of the skin and mucous membranes, but also by the development of encephalitis, myocarditis, and pneumonia. The disease was characterized by an acute onset, with a pronounced intoxication syndrome, signs of pancreatitis with the appearance of a widespread vesicular rash on the trunk and extremities, prone to fusion, located, including on the scalp, on the feet and palms. The disease was complicated by a secondary bacterial infection, in connection with which the patient received both antiviral treatment and broad-spectrum antibiotic therapy. The virus was assigned to clade 3 (or E2 genotype according to the old classification), the same genotype as the viruses circulating in Minsk. This case is the first described case of generalized VZV infection in the Republic of Belarus, confirmed by laboratory using molecular genetic methods.