SHM Converge Scientific Abstract ePoster Gallery-Disseminated Herpes Zoster in Patients Treated With B-Cell Receptor Pathway Inhibitors

Pdf Summary

This case report describes disseminated varicella-zoster virus (VZV) infection in an 85-year-old woman with non-Hodgkin’s B-cell lymphoma treated with ibrutinib, a Bruton’s tyrosine kinase (BTK) and interleukin-2-inducible kinase inhibitor used in the B-cell receptor pathway. Because BCR inhibitors alter immune signaling, they may increase susceptibility to opportunistic infections such as herpes zoster, especially in older or immunocompromised patients.<br /><br />The patient presented to the emergency department with progressive weakness, recurrent falls, waxing and waning mental status, fever, chills, worsening pain, and purulent eye discharge. She had previously been diagnosed by her primary care physician with herpes zoster two weeks earlier. Physical examination showed a diffuse vesicular rash in various stages of healing, bilateral conjunctival injection, and confluent bullous lesions on the right upper extremity. Laboratory studies revealed mild leukocytosis, elevated lactate, and acute kidney injury. Cerebrospinal fluid cultures were positive for VZV, confirming disseminated infection with ophthalmic involvement (zoster ophthalmicus).<br /><br />She was treated with intravenous acyclovir and ophthalmic antimicrobials/antivirals. The report emphasizes that complication rates of herpes zoster are much higher in immunocompromised patients than in the general population, and that disseminated VZV has been reported in patients receiving ibrutinib, though evidence remains limited.<br /><br />The authors conclude that patients on B-cell receptor inhibitors should be individually risk stratified for antiviral prophylaxis and that clinicians should carefully consider inpatient IV acyclovir versus outpatient oral therapy based on severity and host factors. Further research is needed to determine whether prophylactic antivirals or other preventive strategies should be routinely used in patients receiving BCR-inhibitor therapies.

Asset Subtitle

Justin Brooke

Meta Tag

Author List Justin Brooke

Category Clinical Vignettes

Concept Varicella-Zoster Reactivation

Concept Disseminated Herpes Zoster

Concept Intravenous Acyclovir

Concept Latency

Concept Dissemination

Distinguished Non-Finalist

Presenter Organization Penn State College of Medicine

Presenting Author Justin Brooke

Track Adult

Keywords

varicella-zoster virus

disseminated infection

ibrutinib

non-Hodgkin lymphoma

herpes zoster

immunocompromised

zoster ophthalmicus

intravenous acyclovir

B-cell receptor inhibitor

opportunistic infection

Varicella-Zoster Reactivation

Disseminated Herpes Zoster

Intravenous Acyclovir

Latency

Dissemination