Disseminated varicella with multiorgan failure in an immunocompetent adult.
A case of fulminant disseminated varicella is reported in a 28-year-old immunocompetent man. He developed hepatitis, severe pneumonia, rhabdomyolysis and disseminated intravascular coagulation, followed by encephalopathy and multiorgan failure despite acyclovir therapy. He spent a total of 3.5 months in intensive care and rehabilitation units. Real-time PCR yielded a rapid diagnosis of varicella-zoster virus (VZV) infection and was used to monitor plasma viral load for 56 days. Plasma viral load peaked at 7.1 log(10)/ml on day 4 after symptom onset, then gradually declined and became undetectable after between 1 and 2 months; viral load in lung fluid followed a similar pattern. The glycoprotein E variant associated with increased VZV virulence was not detected, and the VZV thymidine kinase gene bore no major mutations associated with acyclovir resistance. This case serves as a reminder that varicella can be life-threatening in adults and that vaccination of individuals at risk remains essential.
Beby-Defaux
Agnès
A
University of Poitiers; University Hospital, Virology Laboratory, Poitiers, France.
Brabant
Séverine
S
Chatellier
Delphine
D
Bourgoin
Anne
A
Robert
René
R
Ruckes
Tobias
T
Agius
Gérard
G
D000328:Adult; D002644:Chickenpox / Q000150:complications* / Q000175:diagnosis* / Q000821:virology; D014645:Herpesvirus 3, Human / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D006801:Humans; D007121:Immunocompetence; D008297:Male; D009102:Multiple Organ Failure / Q000150:complications*; D016133:Polymerase Chain Reaction / Q000379:methods; D019562:Viral Load