Age: 46.0
Sex: M
Vaccine: PNC13, TDAP, VARCEL, VARCEL
Symptoms: Culture, Herpes zoster disseminated, Polymerase chain reaction, Rash vesicular, Varicella post vaccine
Clinical narrative: Information has received from an infectious disease physician concerning a 46 year old male patient with graft versus host disease, hypertension, gastrooesophageal reflux disease (GERD), end stage renal disease requiring hemodialysis, and a history of insomnia, hyperglycemia, and stem cell transplant. Prior vaccinations included M-M-R II) on 10-APR-2017. On 26-MAY-2017, the patient was vaccinated with VARIVAX, subcutaneously (lot # unknown) "in order to become eligible for a kidney transplant." The VARIVAX was reconstituted with sterile diluent (MSD). Concomitant therapies included metoprolol, calcium acetate, amlodipine, hydroxyzine, prednisone, folic acid, melatonin, and lisinopril (manufacturers unknown), and AMBIEN. The physician reported that the patient developed a "disseminated varicella rash" on an unspecified date after receiving a dose of VARIVAX. The patient was admitted to the hospital on 23-JUN-2017 and discharged on 27-JUN-2017. The patient received "a high dose of acyclovir" while hospitalized for the varicella rash. The physician reported that there was no visceral involvement. The physician reported that the varicella rash was "potentially life threatening" and also that the adverse event caused a significant disability or incapacity because the patient was hospitalized for four days. The physician requested a varicella zoster virus (VZV) analysis. VZV serology IgG > 135 (negative), IgM 4.32 (positive), VZV phototoxic reaction (PTR) from blood 69000 and from lesion 280 million. The patient was reported to be recovering. No additional information was provided. Follow-up information was received on 12-JUL-2017 from the physician concerning a 46 year old male patient with no known drug allergies and with history of plasmacytoid dendritic cell neoplasia/plasma amyloid malignancy status post (s/p) double cord hematopoietic stem cell transplantation (HSCT) with current post-transplant graft versus host disease (on chronic low dose prednisone [now alternating doses; previously 10 mg daily] which he was on at the time of vaccination). Other concomitant medications included: lisinopril, metoprolol XL, amlodipine, folic acid, calcium acetate, and pantoprazole (manufacturers unknown). The patient has renal failure on hemodialysis and is in work-up for kidney transplant (still pre-kidney transplant). As part of the protocol, an oncologist provided a prescription for the patient to obtain the VARIVAX, which he received at a pharmacy on 26-MAY-2017. There was no rash at the site of injection. On 23-JUN-2017, the patient developed a vesicular rash on his chest, back, arms bilaterally, and a few on his face and legs with >100 chickenpox lesions. The patient was afebrile and had no recent chickenpox or shingles exposure. The patient recovered from the chickenpox on 12-JUL-2017. A Varicella Zoster Virus Identification Program (VZVIP) vesicle/lesion specimen was collected on 24-JUN-2017. Disseminated varicella rash/Chickenpox was considered to be disabling and potentially life-threatening. Additional information has been requested.