Varicella Pneumonia: Case Report and Review of a Potentially Lethal Complication of a Common Disease

Abstract

Varicella zoster virus causes varicella (chickenpox). It can be reactivated endogenously many years later to cause herpes zoster (shingles). Although varicella is usually a benign disease in healthy children, it resulted in over 11 000 hospitalizations and over 100 deaths every year, in all ages, in the United States. Morbidity was considerably worse in older teenagers and adults. Between 5% and 15% of cases of adult chickenpox will produce some form of pulmonary illness. Progression to pneumonia risk factors include pregnancy, age, smoking, chronic obstructive pulmonary disease, and immunosuppression. Typically, pulmonary symptoms occur 1 to 6 days after varicella zoster infection. They often include cough, fever, and dyspnea. Treatment is a 7-day course of intravenous acyclovir for varicella pneumonia. Early intervention may modify the course of this complication. This review illustrates practical features with a case of a 34-year-old female with severe varicella pneumonia. Despite the lack of significant past medical history and absence of immunosuppression, her pneumonia worsened and by using continuous positive airway pressure mask, intubation was avoided. More important, the radiographic progression of severe varicella pneumonia is shown. This highlights how a common disease of varicella can progress in an adult and manifest with significant organ malfunction.

Varicella-zoster virus post-exposure management and prophylaxis: A review

“…Maternal varicella pneumonia is the most common complication of VZV infection during pregnancy. Approximately 10% to 20% of pregnant women acutely infected with varicella will develop pneumonia (Lamont et al, 2011, Bapat and Koren, 2013), and the risk for maternal varicella pneumonia increases between week 28 of pregnancy through delivery (Denny et al, 2018). Morbidity and mortality related to varicella pneumonia is higher among pregnant women than in the general adult population (Lamont et al, 2011, Bapat and Koren, 2013).…”

“…Morbidity and mortality related to varicella pneumonia is higher among pregnant women than in the general adult population (Lamont et al, 2011, Bapat and Koren, 2013). Estimates of mortality related to varicella pneumonia approach 50% in pregnant women, compared with approximately 11% among healthy adults (Denny et al, 2018).…”

Severe Varicella Pneumonia in an Immunocompetent Adult

“…The use of steroids for severe infections is controversial, and it requires further investigation (3). Nearly 40% of patients with Varicella zoster virus pneumonia require mechanical ventilation, and mortality rate is approximately 10% in adults with any co-morbid conditions (1,3). The image of varicella zoster virus pneumonia is presented here.…”

“…Depending on severity, 7-10 days of oral or intravenous acyclovir treatment is the first-line therapy. Valacyclovir, famciclovir, brivudin, and foscarnet can be used depending on the patient's clinical and metabolic status (3). The use of steroids for severe infections is controversial, and it requires further investigation (3).…”

“…Valacyclovir, famciclovir, brivudin, and foscarnet can be used depending on the patient's clinical and metabolic status (3). The use of steroids for severe infections is controversial, and it requires further investigation (3). Nearly 40% of patients with Varicella zoster virus pneumonia require mechanical ventilation, and mortality rate is approximately 10% in adults with any co-morbid conditions (1,3).…”