Late‐onset visceral varicella‐zoster virus infection presented as acute liver failure after allogeneic hematopoietic stem cell transplantation

Although much less common than localized zoster, initial presentation of varicella‐zoster virus (VZV) as visceral infection can occur especially after allogeneic hematopoietic stem cell transplantation (HSCT). We herein report a case of post‐transplant visceral VZV infection presenting as fatal acute liver failure. It developed 4 years after allogeneic HSCT when a long‐term prophylactic anti‐VZV agent administration was discontinued. VZV should be listed as a causative pathogen of acute liver failure even years after allogeneic HSCT. Indication for, and duration of anti‐VZV prophylaxis should be further investigated.