title: Disseminated varicella with multiorgan failure in an immunocompetent adult.
abstract: 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.
authors.affiliation: University of Poitiers; University Hospital, Virology Laboratory, Poitiers, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Beby-Defaux
authors.forename: Séverine
authors.initials: S
authors.lastname: Brabant
authors.forename: Delphine
authors.initials: D
authors.lastname: Chatellier
authors.forename: Anne
authors.initials: A
authors.lastname: Bourgoin
authors.forename: René
authors.initials: R
authors.lastname: Robert
authors.forename: Tobias
authors.initials: T
authors.lastname: Ruckes
authors.forename: Gérard
authors.initials: G
authors.lastname: Agius
mesh_terms: 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