Disseminated, persistent, and fatal infection due to the vaccine strain of varicella-zoster virus in an adult following stem cell transplantation

Clin Infect Dis. 2015 Apr 1;60(7):1068-74. doi: 10.1093/cid/ciu970. Epub 2014 Dec 1.


Live attenuated varicella vaccine is recommended for healthy individuals who are susceptible to varicella. Although the vaccine is safe, effective, and used worldwide, serious adverse events have been reported, mainly in immunocompromised patients who subsequently recovered. Here, we describe the fatality of an immunocompromised patient who received the varicella vaccine. His medical history provides a cautionary lens through which to view the decision of when vaccination is appropriate. A middle-aged man with non-Hodgkin lymphoma received chemotherapy and a stem cell transplant. He was vaccinated 4 years post-transplantation, despite diagnosis of a new low-grade lymphoma confined to the lymph nodes. Within 3 months of vaccination, he developed recurrent rashes with fever, malaise, weakness, hepatitis, weight loss, and renal failure. The syndrome was eventually determined to be associated with persistent disseminated zoster caused by the vaccine virus. This case illustrates a circumstance when a live viral vaccine should not be used.

Keywords: granulomas; vOka; vaccine; varicella; zoster.

Publication types

  • Case Reports
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Chickenpox Vaccine / adverse effects*
  • Fatal Outcome
  • Herpesviridae Infections / diagnosis*
  • Herpesviridae Infections / pathology*
  • Herpesvirus 3, Human / isolation & purification*
  • Humans
  • Immunocompromised Host
  • Lymphoma, Non-Hodgkin / complications
  • Lymphoma, Non-Hodgkin / therapy
  • Male
  • Middle Aged
  • Stem Cell Transplantation / adverse effects*


  • Chickenpox Vaccine