Primary varicella pneumonia with respiratory failure

Abstract

Varicella pneumonia is a rare but serious and occasionally fatal complication of infection with varicellazoster. A 40-year-old man was admitted to our hospital with fever, eruptions, dyspnea, and severe hypoxemia. A chest X-ray film showed diffuse nodular infiltrative shadows in both lung fields. Transbronchial lung biopsy was done, and examination of the specimen revealed an organizing exudative reaction in the alveolar spaces, as well as interstitial inflammation. Primary varicella pneumonia was diagnosed on the basis of family history, typical eruptions, high titer of antibody against varicellazoster virus, and pathological findings. The patient was treated with methylprednisolone, antibiotics, acyclovir, and immunoglobulin. The skin eruptions and disturbances of gas exchange and diffusion resolved in about one week, but the infiltrative shadows on chest X-ray films remained for more than eight weeks.