Varicella pneumonia in an adult

A 45-year-old man presented with a 2-day history of fever, rash and cough. He smoked cigarettes (30/day for 25 years). He worked in a nursing home where a resident had recently been diagnosed with chickenpox; he had neither been vaccinated against the disease nor had a history of it. Physical examination revealed a rash with vesicles, pustules and crusty lesions (Fig 1). Chest X-ray showed suspicious patchy opacities in both lung fields (Fig 2). Computed tomography displayed multiple nodules, some with a halo of ground-glass attenuation (Fig 3). The presence of Varicella–Zoster virus immunoglobulin M in serum confirmed the diagnosis. Testing for human immunodeficiency virus was negative. Valaciclovir administration led to symptom resolution, and the patient was discharged on day 13 with fully crusted lesions.

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FIG 1.

Physical examination revealed a rash with vesicles, pustules and crusty lesions

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FIG 2.

Chest X-ray showed suspicious patchy opacities in both lung fields

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FIG 3.

Computed tomography revealed multiple nodules, some of which were surrounded by a halo of ground-glass attenuation (arrows).

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Adult varicella can lead to severe complications such as varicella pneumonia.¹ Risk factors for varicella pneumonia include pregnancy, smoking, chronic obstructive pulmonary disease and immune suppression.² Typically, pulmonary symptoms occur 1–6 days after the onset of Varicella–Zoster infection.³ Common clinical manifestations include cough, dyspnoea and fever. The overall mortality rate of varicella pneumonia in adults ranges between 10% and 30%.⁴ Early intervention may modify the natural course of this complication. Typical lung computed tomography findings include multiple nodules with a halo sign, bilateral consolidation and ground-glass opacities.¹ The introduction of varicella vaccination and an improvement in vaccination coverage are crucial for diminishing the incidence of varicella infection, including cases of varicella pneumonia.