Chickenpox is a common childhood disease caused by the varicella zoster virus (VZV). Although rare, varicella pneumonia (VP) is the most common and serious complication of chickenpox in adults. ^1-2

We present images from a 56 year-old immunocompetent male, smoker, with no previous VZV infection, and 5 days history of fever and skin rash. Patient admited recent contact with another person with chickenpox. On examination, he was febrile, had extensive polymorphic pruritic rash, with multiple stage lesions (fig.1). Revealed signs of respiratory distress (respiratory rate 28 breaths/min) . On pulmonar auscultation were present bilateral crackles.

Blood analysis exhibited thrombocytopenia, mild elevation of liver enzymes, lactate dehydrogenase and CRP. Blood arterial gases were consistent with hypoxemic respiratory failure (PaO₂ of 48 mmHg). Chest X-ray revealed a pulmonary bilateral reticular-micronodular pattern, with multiple ill defined micronodules and patchy areas of consolidation, common in VP (fig.2).

Based on the positive contact history, typical skin rash and pulmonary findings, the diagnosis of VP was established. Treatment with aciclovir 10 mg/kg iv 8/8h was started but the patient condition deteriorated resulting in ICU admission. Full recovery was achieved with mechanical ventilation and anti-viral therapy.

Figura I

Skin examination revealing an extensive rash with macular, vesicles, pustules and crusty lesions.

Figura II

Thorax radiography showing bilateral interstitial reticular infiltrates, with multiple ill defined micronodules and patchy areas of consolidation.

  BIBLIOGRAFIA  

1. Gregorakos L, Myrianthefs P, Markou N, Chroni D, Sakagianni E. Severity of illness and outcome in adult patients with primary varicella pneumonia. Respiration. 2002;69(4):330-4.

2. Nee PA, Edrich PJ. Chickenpox pneumonia: case report and literature review. J Accid Emerg Med. 1999 Mar;16(2):147-50.