Objectives: To describe a rare case of varicella complicated by herpetic folliculitis and subsequent intra-abdominal complications.
To highlight the potential for atypical presentations and severe complications of varicella infection.
To emphasize the importance of vigilant clinical observation and a multidisciplinary approach in managing patients with varicella.
To raise awareness among clinicians about the potential for severe complications associated with varicella infection.
Introduction: Varicella, commonly known as chickenpox, is a highly contagious viral infection caused by the varicella-zoster virus (VZV). It primarily affects children but can also occur in adults. Herpetic folliculitis is a skin infection caused by the herpes simplex virus (HSV), which can infect hair follicles and surrounding skin. While both infections are relatively common, their co-infection, especially in severe cases, is less frequent. The epidemiology and incidence of this co-infection are not well-documented, as it often occurs as a complication of a primary varicella infection.
Materials / method: A 42-year-old male presented with a 4-week history of an acute onset of multiple, painful, fluid-filled vesicles on the face, neck, and nape, preceded by varicella exposure. This was followed by a widespread eruption, fever, malaise, and systemic symptoms. Tzanck smear and a 4-mm skin punch biopsy was done and revealed (+) multinucleated cells and intraepidermal blister with ballooning degeneration consistent with varicella / herpes virus infection, respectively. He was initially managed for varicella infection with acyclovir, with subsequent resolution of the initial lesions.
Results: However, he developed persistent abdominal pain, with crackles on bilateral lower lung fields and new skin lesions notably with perifollicular involvement on the trunk and extremities, leading to multiple hospital admissions and investigations, including a diagnosis of intra-abdominal infection. At the time of referral to our service, he presented with multiple hypopigmented to hyperpigmented plaques with brown crusts and severe pruritus. Furthermore, workups for HIV and other STDs were negative. Patient was continued on topical medications with satisfactory results hence discharge on recovery
Conclusion: This case report highlights the unusual presentation of varicella with complications, including the development of herpetic folliculitis and subsequent intra-abdominal complications. This case underscores the importance of vigilant clinical observation and a multidisciplinary approach in managing patients with varicella, especially in those with atypical presentations or complicated courses.
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