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CLINICAL IMAGE
Year : 2013  |  Volume : 138  |  Issue : 1  |  Page : 149

Varicella pneumonia in an adult


1 Internal Medicine Department, Baixo-Vouga Hospital Center, Aveiro, Portugal
2 Infectiology Department, Baixo-Vouga Hospital Center, Aveiro, Portugal

Date of Web Publication6-Aug-2013

Correspondence Address:
Gonçalo Marto
Internal Medicine Department, Baixo-Vouga Hospital Center, Aveiro
Portugal
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Source of Support: None, Conflict of Interest: None


PMID: 24056571

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How to cite this article:
Marto G, Nunes S. Varicella pneumonia in an adult. Indian J Med Res 2013;138:149

How to cite this URL:
Marto G, Nunes S. Varicella pneumonia in an adult. Indian J Med Res [serial online] 2013 [cited 2020 Aug 15];138:149. Available from: http://www.ijmr.org.in/text.asp?2013/138/1/149/116209

A 35-year old man presented to the emergency room with sudden onset of fever, dyspnoea, bilateral pleuritic thoracalgy, and an exanthematous vesicular rash. He was a smoker and his two year-old son had chickenpox two weeks earlier. The patient had no previous immunization or known contact with the disease. On examination, he was febrile (39° C) with signs of respiratory distress (oxygen saturation of 88% on room air). An extensive polymorphic pruritic rash with macular, vesicles, pustules and crusty lesions was noticed [Figure 1]. Laboratory studies showed mild thrombocytopenia and elevation of liver enzymes (AST, ALT, GGT) and lactate dehydrogenese (LDH). Chest X-ray revealed multinodular interstitial infiltrates in both lungs [Figure 2]. Arterial blood gases were consistent with hypoxemic respiratory failure (PaO 2 of 51.8 mmHg). HIV testing was negative. The diagnosis of varicella pneumonia with mild liver involvement on an immunocompetent patient was made and supportive treatment and intravenous acyclovir (10 mg/kg every 8 h) was promptly initiated. Excellent clinical and radiological evolution was documented, as was analytical normalization. After one week of therapy, the patient was discharged fully recovered.
Figure 1: Skin examination: Polymorphic pruritic rash with macular, vesicles, pustules and crusty lesions.

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Figure 2: Chest radiographic: Bilateral multinodular interstitial infiltrates.

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Varicella pneumonia has an approximate incidence of 1:400 cases, being the main cause of morbility and mortality reaching up to 50 per cent in patients requiring mechanical ventilation [1],[2] . Male gender [2] and tobacco use [3] are know risk factors. Respiratory symptoms, mainly dyspnoea and dry cough develop after a few days of rash onset, although pleuritic chest pain and haemoptysis can occur. Patients usually demonstrate progressive hypoxemia and chest radiographs reveal diffuse bilateral infiltrates. Supportive care and acyclovir are the mainstay of treatment. Mechanical ventilation, and probably steroids [1] are reserved for life-threatening varicella pneumonia. The vast majority of healthy adults exibhits complete recovery [4] .

 
   References Top

1.Mer M, Richards GA. Corticosteroids in life-threatening varicella pneumonia. Chest 1998; 114 : 426-31.  Back to cited text no. 1
[PUBMED]    
2.Weber DM, Pellecchia JA. Varicella pneumonia: Study of prevalence in adult men. JAMA 1965; 192 : 572-3.  Back to cited text no. 2
[PUBMED]    
3.Fairley CK, Miller E. Varicella-Zoster virus epidemiology- a changing scene? J Infect Dis 1996; 174 (Suppl 3) : S314-9.  Back to cited text no. 3
[PUBMED]    
4.Jones AM, Thomas N, Wilkins EGL. Outcome of varicella pneumonitis in immunocompetent adults requiring treatment in a high dependency unit. J Infect 2001; 43 : 135-9.  Back to cited text no. 4
    


    Figures

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