Acyclovir in Varicella Pneumonia in Healthy Adults

We read with interest the recent report by Gogos et al. [1] dealing with acyclovir treatment of varicella pneumonia in healthy adults. As pointed out by the authors, this topic has received relatively little attention in the medical literature. We recently used acyclovir in the treatment of a young healthy male with varicella pneumonia. We describe our experience below. A 38-year-old Hispanic male smoker (10 pack-years), without significant past medical history, presented with a generalized varicel-liform rash, nausea, vomiting, cough, pleuritic chest pain and fever (103.3 °F). He had no history of chicken pox as a child and reported visiting a niece with chicken pox 2 weeks prior to presentation. Physical exam showed bilateral rales and diffuse vesicular skin lesions. Chest X-ray was significant for a diffuse bilateral alveolar infiltrate (fig. 1). Arterial blood gases were as follows; pH 7.41, pCOz 27, PaOz 50. The patient was admitted to the intensive care unit and was started on intravenous ox-acillin, erythromycin, cefotaxime and acyclovir (745 mg i.v. every 8 h). Acyclovir was continued for a 10-day course. Due to oxygen de-