Cytosine arabinoside therapy for disseminated herpes zoster in a patient with IgG pyroglobulinemia.

P ATIENTS WITH LYMPHOMA, leukemia, multiple myeloma, or other conditions characterized by an altered immunologic state have an increased susceptibility to the manifestations of common viral infections. In such patients, disseminated infections with the DNA viruses, herpes simplex, and herpes zoster have carried a poor prognosis.1’2 Various attempts have been made to treat these disseminated infections with antiviral agents which act by interfering with DNA synthesis. 5-iodo-2desoxyuridine ( IUDR ) has been used in the treatment of disseminated herpes zoster,3 herpes simplex encephalitis,4 and in the topical therapy of herpes keratitis.5 However, systemic IUDR therapy has been associated with severe toxicity to bone marrow and liver. A recently developed pyrimidine nucleoside analog, cytosine arabinoside, selectively interferes with DNA synthesis.#{176}’7 It inhibits the growth of herpes simplex and herpes zoster viruses in vitro and is useful as topical therapy for herpetic keratitis, both in experimental animals and in man.8’#{176} Systemic therapy with cytosine arabinoside has been effective in the treatment of human acute leukemia and lymphoma10’ and has generally been well tolerated. Cystosine arabinoside has not, however, been previously used in the treatment of disseminated human herpetic disease. The occurrence of a progressive, disseminated herpes zoster infection in a patient with a dysproteinemia and an advanced lymphoproliferative disorder offered an opportunity to investigate the effects of cytosine arabinoside upon these two diseases’2