Abstract:

Objective    To discuss the diagnosis, high risk factors, prevention and treatment of disseminated varicella zoster virus（VZV） infection after allogeneic hematopoietic stem cell transplantation（allo-HSCT） in children with aplastic anemia（AA）. Methods    A retrospective analysis was made about the clinical data of 3 children with disseminated VZV infection after allo-HSCT for AA. Results    Three children, aged 10～13 years old，who didn’t present graft-versus host disease（GVHD） after transplantation, were given single drug as anti-viral prophylaxis of VZV. During the period of prophylaxis, none of them developed VZV reactivation but they showed symptoms of disseminated VZV infection after discontinuation of anti-viral prophylaxis. All of them were treated with intravenous ganciclovir, oral valaciclovir combined with external application of penciclovir and with gamma globulin until the rush crusted, and eventually all of them recovered well. Conclusion    Patients with allo-HSCT for aplastic anemia are at high risk of developing disseminated VZV infection and they have high incidence of mortality and poor prognosis. We recommend anti-viral prophylaxis after allo-HSCT for prevention， and reduced dose of immunosuppressive drugs and combination use of ganciclovir, valaciclovir and gamma globulin when patients present symptoms of VZV infection.

Key words: child, aplastic anemia, allogeneic hematopoietic stem cell transplantation, disseminated varicella zoster virus infection

摘要：

目的    探讨儿童再生障碍性贫血（AA）造血干细胞移植（HSCT）后并发播散型带状疱疹的诊断、高危因素、预防及治疗措施。方法    回顾性分析2014年12月至2015年9月中山大学孙逸仙纪念医院儿科收治的3例AA患儿接受全相合非血缘相关供者HSCT后予免疫抑制剂治疗期间出现播散型带状疱疹的临床资料。结果    3例患儿年龄分别为13、12和10岁，移植后未出现移植物抗宿主病，予抗病毒药物单药预防水痘-带状疱疹病毒（VZV）期间均未出现VZV再激活，在HSCT后4.0、5.5和8.0个月停用抗病毒药物，分别在停用抗病毒药物后13.0、10.5和3.0个月出现皮肤播散型带状疱疹，予静脉更昔洛韦联合口服伐昔洛韦及外用喷昔洛韦抗病毒治疗至皮疹结痂，并予丙种球蛋白治疗，均完全治愈。结论    接受HSCT的AA患者是播散型带状疱疹的高发人群，其发病率高、病情严重且病死率高。移植后予预防性抗病毒处理，出现播散型带状疱疹时减少免疫抑制剂量，联合更昔洛韦、伐昔洛韦及丙种球蛋白治疗，可明显改善疗效。

关键词: 儿童, 再生障碍性贫血, 异基因造血干细胞移植, 播散型带状疱疹