Acyclovir treatment of disseminated varicella in childhood malignant neoplasms
S. T. Shulman
Primary varicella-zoster virus infection (chickenpox) in immunocompromised
children is frequently associated with visceral dissemination and attendant
high mortality. Eight children with malignant neoplasms and chickenpox with
visceral involvement (seven with hepatitis, three with pneumonitis, two
with encephalitis, and two with coagulopathy) were initially treated with
intravenously (IV) administered vidarabine but demonstrated progressive
visceral involvement. After three days of vidarabine treatment (two days
for two patients), seven had rising serum SGPT levels, all eight had
pneumonitis, seven had deteriorating mental status and/or seizure activity,
and six had worsening coagulopathy. Vidarabine was replaced by IV
administered acyclovir, with subsequent improvement in all but the most
severely ill patient who died. Seven of eight patients recovered
completely; no side effects of acyclovir were observed. This clinical
experience suggests that acyclovir may be more effective than vidarabine in
disseminated varicella infection; however, controlled clinical trials will
be necessary to establish this.
