Severe Varicella in adult
Loubna Benchat1,&, Fatima Zahra Mernissi1
1Department of Dermatology, CHU Hassan II, Fes, Maroc
Loubna Benchat, Department of Dermatology, CHU Hassan II, Fes, Maroc
A 35-year-old man presented to the emergency with a 5-day history
of fever, chest pain and exanthematous vesicular pruritic rash.
His 10-year-old son had been diagnosed with chickenpox 2 weeks
earlier. He had no history
of chickenpox. On presentation, he was febrile 39.4°C,
heart rate was 100 beats/min, and respiratory rate was 26 breaths/min.
An extensive rash with macular and vesicles was noticed. The lesions
necrotic and hemorrhagic. The lesions were widespread affecting
the face, trunk and the limbs. Laboratory studies showed thrombocytopenia
of liver enzymes (AST, ALT). Chest X-ray revealed multinodular interstitial
infiltrates in both lungs. The diagnosis of varicella with pneumonia
and liver involvement was made. Varicella, the primary varicella-zoster
infection, is predominantly a childhood disease in non-vaccinated
populations. Although, it usually results in mild to moderate
illness, serious complications
can arise. Older age and a compromised immune system are the most
important risk factors associated with severity of varicella disease.
like in our patient, complicates between 5% and 15% of instances
of adult chickenpox. Risk factors for progression to pneumonia
smoking, older age, chronic obstructive pulmonary disease and immune
suppression. In patients who are immunocompromised, the mortality
approaching 50% despite
treatment. Most healthy adults have favourable outcomes. The other
complications are secondary bacterial infections, Invasive infections
necrotizing fasciitis, the central nervous system and ocular involvement).
Treatment with intravenous antiviral is mandatory for patients with
An extensive vesicular rash with large necrotic and hemorrhagic