Progressive varicella syndrome with Varicella gangrenosa in an immune-competent infant

Sonia Bhatt,Nalini Bhaskaranand,Meenu Joon,Kashyap Udupa

doi:10.7241/ourd.20133.87

Abstract

Varicella is common and highly contagious and affects nearly all susceptible children before adolescence. Progressive varicella syndrome is a severe complication of primary Varicella Zoster Virus (VZV) infection, with visceral organ involvement, coagulopathy, severe hemorrhage, and continued vesicular lesion development. We report a rare case of progressive varicella syndrome with varicella gangrenosa in a previously well female child of ten months. She presented with history of recurrent vesiculo-bullous skin lesions involving the chest, back and extremities since two months with dry gangrene of 1st, 3rd and right great toe. VZV Polymerase Chain Reaction (PCR) of vesicle fluid was positive. Workup for immunodeficiency state was negative. She responded dramatically to intravenous acyclovir.

Highlights

Varicella, commonly known as chickenpox, is caused by the varicella-zoster virus and causes primary, latent, and recurrent infections
Progressive varicella is a severe complication of primary varicella-zoster virus (VZV) infection, with visceral organ involvement, coagulopathy, severe hemorrhage, and continued vesicular lesion development [4]
Varicella gangrenosa is a rare complication of this disease, infrequently reported in the literature [5,6]

Summary

Introduction

Commonly known as chickenpox, is caused by the varicella-zoster virus and causes primary, latent, and recurrent infections. Progressive varicella is a severe complication of primary VZV infection, with visceral organ involvement, coagulopathy, severe hemorrhage, and continued vesicular lesion development [4]. We report a case of progressive varicella syndrome with varicella gangrenosa in an immune-competent female child of ten months. Case report A ten month old female baby to us with history of recurrent vesiculo-bullous skin lesions involving the chest, back and extremities since two months with recent progression to palms and perianal area, abdominal distention, tachypnoea, swelling of bilateral lower limbs and discoloration of toes of right foot. On admission child was lethargic, had multiple confluent hemorrhagic, vesiculo-bullous lesions all over body (Fig. 1), anasarca predominantly in bilateral lower limb with dry gangrene of 1st,3rd and great toe (right) and bilateral crepitations in chest. Her general condition improved and her lesions started healing by day five and she was discharged after fifteen days

Discussion

Conclusion