Internal medicine (Tokyo. 1992)
A 29-year-old woman who was a current smoker presented with a rash which had started in the trunk and then rapidly progressed throughout her whole body. She did not have a past history of chicken pox nor was she vaccinated against it. Her two-year-old daughter had chicken pox 2 weeks earlier. She did not complain of cough or breathlessness. She did not complain of headaches or drowsiness. On examination she had a widespread erythematous rash with various stages of vesiculation typical of
... n typical of chicken pox (Picture 1). Her axillary temperature was 39.6 . Her respiratory rate of was 18/minute. Systemic examination was normal. Her full blood count and a biochemical profile were normal. A chest radiograph (Picture 2) showed widespread bilateral nodular opacities characteristic of varicella zoster pneumonitis (VZP). She was successfully treated with acyclovir. Pneumonitis is an uncommon complication of chicken pox; it is estimated to occur in 1 in 400 cases. In adults, changes on a chest radiograph are much more common with an incidence of 5-50% (1). Varicella pneumonitis can be a fulminant illness; however a majority of patients remain asymptomatic, as in the present case. In adults previous VZP is often recognized by characteristic diffuse military calcification as an incidental finding (2). The authors state that they have no Conflict of Interest (COI ). References 1. Mohsen AH, McKendrick M. Varicella pneumonia in adults. Eur Respir J 21: 886-891, 2003. 2. Floudas CS, Kanakis MA, Andreopoulos A, Vaiopoulos GA. Nodular lung calcifications following varicella zoster virus pneumonia. QJM 101: 159, 2008.