Varicella-Zoster Infection with Encephalopathy, Pneumonia, and Renal Failure: A Case Report

Abstract

Primary varicella-zoster (VZ) infection is rare in adults, but the rate of morbidity and mortality is higher than in children. Pneumonia is the most common complication of primary VZ infection in adults. Moreover, varicella pneumonia associated with acute renal failure and acute encephalopathy is very rare. This study reports on a case of disseminated VZ infection successfully treated with acyclovir. The patient was otherwise healthy and denied previous systemic or infectious disease. The initial diagnosis was varicella pneumonia. However, multiple organ involvement subsequently was found in several organs, including the kidney, brain, lung, liver, blood, and skin. The reactivation of VZ infection was strongly suspected. Abnormal renal and liver function and thrombocytopenia also were noted. The patient with chickenpox was treated successfully with acyclovir without complication. In conclusion, multiple organ involvement is a rare complication of VZ infection in adults. In the severe case presented here, adequate intravenous acyclovir administration and close observation of the general condition were essential for successfully treating disseminated VZ infection without complications.

Varicella Pneumonia with Acute Kidney Injury in an Immunocompetent Host

“…Similar to this case renal involvement leading to AKI with varicella pneumonia has been described in adults. 7 Varicella pneumonia is one of the serious complications presenting in a healthy child. 8 Mortality rate among children with varicella pneumonia varies and has considerably decreased in post vaccination era.…”

Use of intravenous immunoglobulin in a disseminated varicella infection in an immunocompromised child

“…However, dissemination of the primary infection can occur, particularly in immunocompromised children1,2,3,4,5,6,7). The lungs, liver, brain and heart are usually involved in progressive varicella1).…”

“…However, it sometimes can be a life-threatening condition, especially in immunocompromised patients such as bone marrow transplant recipients, who are receiving corticosteroids therapy or chemotherapy and patients with human immune deficiency virus infection1,2,3,4,5,6,7,8). Although, it is very rare, VZV infection can be also lead to severe illness in immunocompetent persons2,3,6,7).…”

Pneumonia and Meningoencephalitis Due to Varicella-zoster Virus Reinfection and Epstein-Barr Virus Reactivation in a Patient with Rheumatoid Arthritis

“…VZV infections in adult patients are known to cause pneumonia, hepatitis, and encephalitis, among others, unlike in children, in whom VZV infections are less severe (4). In addition, eight cases complicated by pneumonia and central nervous system infection have been reported in previous studies (5)(6)(7)(8)(9)(10)(11)(12). The modes of infection in these cases were reported to be reactivation in four cases, primary infection in one case, and VZV reinfection in one case; however, the modes of infection in the remaining cases were not reported.…”