Visceral varicella zoster infection after bone marrow transplantation without skin involvement and the use of PCR for diagnosis.

A 41-year-old patient with acute myeloid leukemia was transplanted from an HLA-identical but ABO-incompatible sibling. The post-transplant course was complicated by pure erythrocyte aplasia and mild chronic graft-versus-host disease. Eleven months after transplant while on steroid therapy she developed abdominal pain rapidly followed by fatal fulminant hepatic failure. Varicella zoster virus (VZV) was detected using the polymerase chain reaction from blood and liver obtained at necropsy even though no skin manifestations of VZV were present. This case confirms previous reports of visceral VZV infection in the absence of skin lesions thus emphasising the importance of suspecting the presence of VZV in this clinical setting and outlines the possible value of PCR in the rapid diagnosis of infection.