Reactions 1022 - 9 Oct 2004

★ SAntineoplastics

Atypical chickenpox (first report with bleomycin,doxorubicin and vincristine): case report

A 35-year-old woman developed atypical chickenpox, with adistribution similar to that of hand-foot-and-mouth disease,during antineoplastic therapy for non-Hodgkin’s lymphoma.

The woman, who had a childhood history of chickenpox,presented with a vesicular eruption on her tongue, palms andsoles during treatment with methotrexate, doxorubicin,cyclophosphamide, vincristine, prednisolone and bleomycin[dosages and duration of treatment not stated]. One weeklater, she developed a fever and her skin eruption worsened,with enlargement of the vesicles on her palms and soles anddissemination to her entire body. She also developed multipleumbilicated vesicles and bullae on her face trunk andextremities. A lesional biopsy showed reticular and ballooningdegeneration of the epidermis with multinucleated giant cells,and intranuclear inclusion bodies in the keratinocytes. PCRanalysis of a blood sample revealed Varicella zoster virus DNA.In addition, her AST and ALT levels increased to 130 and242 U/L, respectively.

The woman was treated with aciclovir and her symptomsimproved, with resolution of her skin eruption within 2 weeks.

Author comment: "We speculate that chemotherapyinduced damage of the acral skin and oral mucosa might beinvolved in the unusual distribution of the vesicular eruption."Osawa M, et al. Atypical varicella mimicking hand-foot-mouth disease in an adultpatient with malignant lymphoma during chemotherapy. British Journal ofDermatology 151: 254-256, No. 1, Jul 2004 - Japan 800987851

» Editorial comment: A search of AdisBase and Medline didnot reveal any previous case reports of chickenpox associatedwith bleomycin, doxorubicin or vincristine. The WHO AdverseDrug Reactions database contained one report of varicellaassociated with bleomycin and one report of varicella associatedwith doxorubicin, but no reports of varicella associated withvincristine.

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Reactions 9 Oct 2004 No. 10220114-9954/10/1022-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved