Unusual varicella zoster virus infection in a patient with colon carcinoma and Evans syndrome--delayed virus shedding generalized recurrent necrotic herpes zoster

A 53-year-old Japanese woman with Evans syndrome and colon cancer had two episodes of herpes zoster. The first painful vesicular rashes involved the right lower abdomen and buttock and healed in one month. After one more month, a second attack occurred on the right thigh and leg and developed into generalized hemorrhagic lesions, which became crusted in about 90 days. The patient died 131 days after the second attack, when the lesions had almost subsided. Varicella-zoster virus (VZV) was isolated on the 59th day of the second attack. Her intracutaneous reactions to VZV antigen was negative, but the humoral antibodies were continuously positive.