Fatal chickenpox in a patient with nephrotic syndrome.
BACKGROUND
We report our experience with two patients with adult onset of chickenpox in the setting of longstanding steroid therapy for nephrotic syndrome. Ours is a 430-bed tertiary care teaching hospital, The Wellesley Hospital, Toronto, Ontario. Both patients presented as self-referrals to the emergency department.


METHODS
The clinical suspicion of chickenpox was rapidly confirmed in both cases by a Tzanck smear preparation, by viral cultures of the vesicle, serology, and skin biopsy. In both patients therapy with high dose acyclovir, 10 mg/kg q8h, intravenously, was instituted based on clinical presentation.


RESULTS
Delay in clinical recognition and treatment in our first case resulted in death due to multiorgan failure (MOF). Improved awareness and rapid treatment of the second patient had a favorable outcome with no sequelae.


CONCLUSIONS
Chickenpox is not only a childhood illness. Although rare in the adult population, it is associated even in the nonimmunocompromised host with increased morbidity and mortality. Steroid therapy predisposes to early dissemination and a potentially fatal outcome. Adults with immunosuppression should receive prompt systemic treatment with acyclovir.
Maté
E S
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Department of Medicine, Wellesley Hospital, Toronto, Ontario, Canada.
Fisher
B K
BK
D000212:Acyclovir / Q000627:therapeutic use; D000328:Adult; D002644:Chickenpox / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure; D009404:Nephrotic Syndrome / Q000150:complications* / Q000188:drug therapy; D011241:Prednisone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D011241:Prednisone; D000212:Acyclovir