Varicella-zoster infection in Hodgkin's disease: Clinical and epidemiological aspects

Abstract

Varicella-zoster eruptions occurred in 8 per cent of patients with Hodgkin's disease. Three types of skin involvement were seen, localized herpes zoster (thirty-nine cases), herpes zoster followed by disseminated varicelliform eruption (ten cases), and generalized varicelliform eruption without zoster (five cases). Four patients had more than one attack of varicella-zoster disease. Almost all patients in whom varicellazoster lesions developed had widely disseminated Hodgkin's disease, and the most important predisposing factor appeared to be the depression of host immune mechanisms associated with advanced Hodgkin's disease. In some cases, exogenous reinfection by varicella-zoster virus appeared to be the proximate etiologic factor, and patient to patient spread within the hospital was incriminated in four instances. However, the seasonal distribution of cases suggested that activation of latent virus was the responsible mechanism in the great majority. Localization of herpes zoster may be determined, at least in some cases, by the location of active sites of Hodgkin's disease. In this series, corticosteroid therapy did not appear to be an important factor in precipitating varicella-zoster disease or causing dissemination of viral lesions. Although in some patients the course of herpes zoster did not differ from that in the general population, the morbidity was clearly greater for the group as a whole. This was manifested not only by the high incidence of generalized eruptions, but also by the severity of segmental zoster, slow evolution of lesions and persistence of inclusion bodies. Localized herpes zoster did not constitute an ominous prognostic sign for patients with Hodgkin's disease, but disseminated eruption did; the median survival of patients with disseminated lesions was less than a year. Large doses of pooled human gamma globulin appeared to exert a favorable effect on varicella-zoster disease in some cases but clearly failed to alter the course of others.