Prolonged Herpes-Zoster Infection Associated with Immunosuppressive Therapy

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Abstract
Unusually prolonged zoster was observed in 4 patients: 2 with cardiac transplants, 1 with acute lymphocytic leukemia and 1 with diffuse histiocytic lymphoma. Lesions increased in number and persisted for 5-24 wk before beginning to resolve. Specific cellular immune responsiveness to varicella-zoster virus was markedly depressed during these infections. Absolute numbers of T [thymus-derived] lymphocytes were very low. Reducing immunosuppressive therapy to increase immune responses appeared to initiate resolution of zoster lesions and halt dissemination. In 1 patient treatment with adenine arabinoside was needed for resolution of disseminated zoster. This syndrome may be a counterpart of the prolonged mucocutaneous herpes simplex infection previously reported in immunosuppressed cardiac and renal transplant patients.