Bhatti M A, Manglani C B, Khan M A.
Fatal case of Chickenpox in an Adult: A case report.
J Pak Med Assoc Jan ;54(2):104-6.

A 42 year old man presented with one week history of intermittent colicky abdominal pain, vomiting and jaundice. Two days prior to admission he developed vesicular skin rash over face, arms and chest. One day prior to admission he passed hard stools mixed with fresh blood. He was recently found to be positive for hepatitis B surface antigen. Four days prior to his illness; two of his children had a febrile illness with vesicular skin rash diagnosed as chickenpox. He was a fisherman by profession, occasionally drank small amount of alcohol and smoked 15 cigarettes daily for the last 30 years. On physical examination, he was jaundiced, had pedal edema and vesicular eruption all over the body particularly in axilla, chest and face. Few of the vesicles were umblicated. He had conjunctival hemorrhage in both eyes. No lymphadenopathy was detected. Bilateral inspiratory crackles were heard at lung bases. Abdominal, cardiovascular and neurological examinations were unremarkable. Initial laboratory workup showed hemoglobin of 13.8 grams/dl, white blood cells 5.7/cmm and platelets were clumped, creatinine 0.9 mg/dl, total bilirubin 2 mg/dl, serum alanine aminotransferase 213, LDH was 2676 and lipase was 537. CT Scan of abdomen revealed nodularity in liver and mild ascites. There was moderate splenomegaly and varices noted along the splenic vein. Findings were suggestive of chronic liver disease with portal hypertension. Bilateral soft tissue infiltrates were noted in the lungs consistent with pneumonitis. A tzank smear of vascular lesion from chest revealed inclusion bodies. Following admission, treatment was started with high dose intravenous acyclovir and meropenam. He required intubation the following day and his clinical condition continued to deteriorate with development of acute renal failure and DIC. He started bleeding from the mouth, nose and endotracheal tube and did not response to aggressive management and died on the 4th day of admission.

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