Citation Information :
Roy S, Surya HM, Rangappa P, Jacob I, Rao K. Atypical Presentation of Varicella-zoster Virus in an Immunocompetent Adult. 2024; 3 (2):105-107.
A 36-year-old male patient with no known comorbidities was referred from another hospital with a history of fever and skin rash for 10 days. He had been clinically diagnosed with varicella-zoster and empirically started on intravenous acyclovir. He had a progressive worsening of dyspnea for which he was brought to this hospital. Blood gases and high-resolution computed tomography (HRCT) of the chest were suggestive of severe acute respiratory distress syndrome (ARDS). He was intubated and mechanically ventilated in the prone position but had a rapidly deteriorating course, eventually succumbing to multiorgan failure and septic shock. Skin biopsy and bone marrow results were inconclusive. Polymerase chain reaction (PCR) for tropical fever viruses showed positive for varicella-zoster immunoglobulin M (IgM). The present case highlights the possibility of varicella-zoster occurring in immunocompetent individuals and the need to be aware of possible complications such as pneumonia.
Ksiazek TG, Erdman D, Goldsmith CS, et al. A novel coronavirus associated with severe acute respiratory syndrome. N Engl J Med 2003;348(20):1953–1966. DOI: 10.1056/NEJMoa030781
Beigel JH, Farrar J, Han AM, et al. Avian influenza A (H5N1) infection in humans. N Engl J Med 2005;353(13):1374–1385. DOI: 10.1056/NEJMra052211
Perez-Padilla R, de la Rosa-Zamboni D, Ponce de Leon S, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med 2009;361(7):680–689. DOI: 10.1056/NEJMoa0904252
Influenza Investigators ANZIC, Webb SAR, Pettilä V, et al. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med 2009;361(20):1925–1934. DOI: 10.1056/NEJMoa0908481
Jennings LC, Anderson TP, Beynon KA, et al. Incidence and characteristics of viral community-acquired pneumonia in adults. Thorax 2008;63(1):42–48. DOI: 10.1136/thx.2006.075077
Crowe JE Jr. Human metapneumovirus as a major cause of human respiratory tract disease. Pediatr Infect Dis J 2004;23(11 Suppl):S215–S221. DOI: 10.1097/01.inf.0000144668.81573.6d
Arnold JC, Singh KK, Spector SA, et al. Human bocavirus: prevalence and clinical spectrum at a children's hospital. Clin Infect Dis 2006;43(3):283–288. DOI: 10.1086/505399
van der Hoek L, Pyrc K, Berkhout B. Human coronavirus NL63, a new respiratory virus. FEMS Microbiol Rev 2006;30(5):760–773. DOI: 10.1111/j.1574-6976.2006.00032.x
Ross AH, Lechner E, Reitman G. Modification of chickenpox in family contacts by administration of gamma globulin. N Engl J Med 1962;267:369–376. DOI: 10.1056/NEJM196208232670801
Center for Disease Control. Varicella-zoster immune globulin for the prevention of chickenpox. Morb Mortal Wkly Rep 1984;33:84–90.
Arabeit RD, Zair JA, Valerio MA, et al. Infection of human peripheral blood mononuclear cells by varicella-zoster virus. Intervirology 1982;18(1-2):56–65. DOI: 10.1159/000149304
Ozaki T, Ichikawa T, Matsui Y, et al. Viremic phase in immunocompromised children with varicella. J Pediatr 1984;104(1):85–87. DOI: 10.1016/s0022-3476(84)80596-x
Sargent NE, Carson MJ, Reilly ED. Roentgenographic manifestations of varicella pneumonia with postmortem correlation. Am J Roentgenol Radium Ther Nucl Med 1966;98(2):305–317. DOI: 10.2214/ajr.98.2.305
Weigle K, Groce C. Varicella pneumonitis: immunodiagnosis with a monoclonal antibody. Pediatrics 1984;105(2):265–268. DOI: 10.1016/s0022-3476(84)80126-2
Wallace MR, Bowler WA, Murray NB, et al. Treatment of adult varicella with oral acyclovir. A randomized, placebo-controlled trial. Ann Intern Med 1992;117(5):358–363. DOI: 10.7326/0003-4819-117-5-358
Sauer M, Vasudevan P, Meghani A, et al. Situational assessment of adult vaccine preventable disease and the potential for immunization advocacy and policy in low- and middle-income countries. Vaccine 2021;39(11):1556–1564. DOI: 10.1016/j.vaccine.2021.01.066
