Disseminated varicella with multiorgan failure in an immunocompetent adult

A case of fulminant disseminated varicella is reported in a 28‐year‐old immunocompetent man. He developed hepatitis, severe pneumonia, rhabdomyolysis and disseminated intravascular coagulation, followed by encephalopathy and multiorgan failure despite acyclovir therapy. He spent a total of 3.5 months in intensive care and rehabilitation units. Real‐time PCR yielded a rapid diagnosis of varicella‐zoster virus (VZV) infection and was used to monitor plasma viral load for 56 days. Plasma viral load peaked at 7.1 log 10 /ml on day 4 after symptom onset, then gradually declined and became undetectable after between 1 and 2 months; viral load in lung fluid followed a similar pattern. The glycoprotein E variant associated with increased VZV virulence was not detected, and the VZV thymidine kinase gene bore no major mutations associated with acyclovir resistance. This case serves as a reminder that varicella can be life‐threatening in adults and that vaccination of individuals at risk remains essential. J. Med. Virol. 81:747–749, 2009 © 2009 Wiley‐Liss, Inc.