A storm of stones in the lungs: an uncommon sequela of varicella pneumonia

Abstract

A 29-year-old female patient, never smoker, restorer by profession, presented with slight malaise and the flu that lasted for a few days. An X-ray of the chest showed various nodules of varying sizes in random distribution and with high density in both lungs, similar to calcifications ( Figure 1A). The laboratory test results were unremarkable. Pulmonary function tests and blood gases were normal: FEV 1 = 3.23 L (97% of predicted); FVC = 3.81 L (98% of predicted); DLCO = 98%; pO 2 = 97 mmHg; and pCO 2 = 39 mmHg. An HRCT of the chest was performed to clarify the chest X-ray findings, showing that the totality of nodules was calcified, but there were no calcified lymph nodes (axial HRCT scan with mediastinal window; Figure 1B). The HRCT scans also showed numerous small bilateral nodules-sharply defined and randomly distributed in both lungs-but no interstitial thickening or any other pathologic findings ( Figures 1C and 1D). Parathyroid function, autoantibodies, and quantiFERON-TB (Cellestis, Ltd., Carnegie, Australia) testing was negative, and blood calcium levels were normal. The patient confirmed a severe varicella infection in childhood (at age 4 years), and antibody testing for the varicella-zoster virus showed positive results (IgG = 348 mIU/mL and IgM = 0.34 mIU/ mL). Varicella (chickenpox) is a contagious viral disease transmitted by respiratory droplets. The development of multiple, small, diffuse nodular calcifications in both lungs with noncalcified lymph nodes is an uncommon sequela of varicella pneumonia.