Disseminated varicella-zoster virus infection during FOLFIRINOX therapy in a patient with pancreatic cancer with local recurrence and distant metastases

Abstract

A 54-year-old man with cancer of the pancreatic body underwent distal pancreatectomy. Chemotherapy was given as second-line treatment for local recurrence and distant metastases. He underwent three courses of FOLFIRIOX (oxaliplatin, irinotecan, fluorouracil and levofolinate calcium regimen) without difficulty. During the fourth course, he developed severe systemic blisters, abdominal pain, and back pain. Varicella was diagnosed based on the varicelliform rash. Acyclovir was given following hospitalization. Fever, hepatic dysfunction and disturbance of consciousness subsequently developed. Varicella zoster virus (VZV) was detected in the cerebrospinal fluid and disseminated VZV infection diagnosed. His condition improved with supportive care including antiviral therapy, steroids, as well as transfusion. The VZV infection resolved. Varicella is known to be aggravated in patients who are in an immunosuppressed state with leukemia or after transplantation. However, reports of varicella infections during chemotherapy for solid tumors are rare. It is necessary to be aware of the potential for such patients to develop a viral infection when they are undergoing chemotherapy for solid tumors.