A case of Varicella Pneumonia in adult

Dr Fazlul Haque, Dr Syeda Fahmida Hossain, Dr Sayeed Sajjad Hossain, Dr Iqbal Hossain, Dr Nazmul Islam, Dr P R Saha, Dr Afsana Begum.
Department of Medicine, United hospital Limited.

A 57 year old gentleman was admitted to the UH on 12.02.12 with the complaints of high grade intermittent fever with vesicular skin lesion for 10 days and cough, dyspnoea mostly orthopnoea for  4 day. He was a known case of DM, HTN, and lumber spondylosis. Examination revealed: pulse- 110/ bpm, B.P- 130/80mm hg, temp- 100º F, R/R-36/minSpO2-86% with room air. Skin- generalized vesicular rashes of eruptive to healing phases consistent with rash of varicella. 

Auscultation of lung revealed bilateral coarse crepitations extending from mid to lower part of chest; His biochemical profile revealed hyponatraemia (117 mmol/L) and AKI (1.77 mg/dl) and raised CRP (72). Chest X ray showed bilateral non-homogenous opacity. With these clinical, biochemical and radiological scenario he was diagnosed as a case of varicella pneumonitis. Patient was treated with injectable acyclovir (Acyclovir,10 mg/kg IV q 8 hours10 days), steroid and others supportive.

Varicella pneumonia usually presents 1-6 days after the onset of the rash and is associated with tachypnea, chest tightness, cough, dyspnea, fever, pleuretic pain, hemoptysis. Chest symptoms may start before the appearance of the skin rash. CXR shows nodular or interstitial pneumonitis Recommended treatment is Acyclovir,10 mg/kg IV q 8 hours10 x 14 days for immuno-competent and 21 days for immuno-suppressed patients. Corticosteroid use shortens hospital stay.