title: Bronchial ulceration as a prognostic indicator for varicella pneumonia: case report and systematic literature review.
abstract: Adult varicella pneumonia is a common and serious complication of varicella zoster virus (VZV) infection in pregnant woman and immunocompromised individuals, with mortality rates of 30-50%. The poor prognosis is attributable to very aggressive disease progression and delayed onset of treatment. Here, we present a case of varicella pneumonia in a 69-year-old woman following long-term immunosuppressive treatment for kidney transplant. Respiratory failure developed within 3 d after admission for skin rash, and the patient died 28 d later despite acyclovir and foscarnet treatment. The autopsy showed extensive mucosal airway ulcerations from the pharynx to the main bronchi and numerous VZV-infected cells. We searched PubMed, Web of Science, and EMBASE (1980 through February 2012), as well as several medical report databases created by Japanese healthcare professionals, for all reported cases of varicella pneumonia for which bronchoscopy findings were documented. Twenty-four cases were included and we found that patients with limited or shallow ulcers had favorable outcomes, whereas patients with vast and deep ulcerations had fatal outcomes. These findings indicate that bronchoscopy findings, particularly those showing bronchial involvement, may be useful for evaluating varicella pneumonia.
authors.affiliation: Department of Emergency and Critical Care Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. inokuchir-icu@h.u-tokyo.ac.jp
authors.forename: Ryota
authors.initials: R
authors.lastname: Inokuchi
authors.forename: Kensuke
authors.initials: K
authors.lastname: Nakamura
authors.forename: Hajime
authors.initials: H
authors.lastname: Sato
authors.forename: Kazuaki
authors.initials: K
authors.lastname: Shinohara
authors.forename: Yuta
authors.initials: Y
authors.lastname: Aoki
authors.forename: Kent
authors.initials: K
authors.lastname: Doi
authors.forename: Masataka
authors.initials: M
authors.lastname: Gunshin
authors.forename: Takeshi
authors.initials: T
authors.lastname: Ishii
authors.forename: Takehiro
authors.initials: T
authors.lastname: Matsubara
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hiruma
authors.forename: Susumu
authors.initials: S
authors.lastname: Nakajima
authors.forename: Naoki
authors.initials: N
authors.lastname: Yahagi
mesh_terms: D000368:Aged; D001980:Bronchi / Q000473:pathology*; D001999:Bronchoscopy; D016208:Databases, Factual; D017809:Fatal Outcome; D005260:Female; D006562:Herpes Zoster / Q000150:complications / Q000175:diagnosis*; D014645:Herpesvirus 3, Human; D006801:Humans; D016030:Kidney Transplantation; D011024:Pneumonia, Viral / Q000150:complications / Q000175:diagnosis*; D011379:Prognosis; D012720:Severity of Illness Index