Title : Severe acute respiratory distress syndrome secondary to viral pneumonia caused by Varicella Zoster: Case report
Abstract:
Viral pneumonia caused by the Varicella Zoster virus is a rare but serious complication with a high mortality rate. A 17-year-old male patient, previously healthy, was admitted to an infectious disease hospital with confluent, polymorphic, centripetal papulovesicular rashes that began seven days earlier, associated with abdominal pain, low back pain, productive cough with purulent sputum, and respiratory distress. Chest X-ray showed diffuse bilateral interstitial infiltrate, consistent with primary viral pneumonia. Laboratory tests showed leukopenia, thrombocytopenia, coagulation disorders, elevated liver enzymes, elevated inflammatory markers, renal dysfunction, and increased canalicular and cardiac enzymes. Abdominal ultrasound revealed active acalculous cholecystopathy. Echocardiogram showed septal wall hypokinesia, global systolic dysfunction, hypokinesia of the septal and anterior walls of the right ventricle, and pulmonary hypertension with right ventricular systolic pressure of 40 mmHg. After five hours of hospitalization, he developed hypoxemic respiratory failure and septic shock, likely of pulmonary origin. Ceftriaxone, acyclovir, and corticosteroid therapy were initiated. The patient developed multiple organ dysfunction: acute renal failure, acute liver failure, myositis, myocarditis, coagulation disorder, loss of lung function with refractory hypoxemia, and irreversible septic shock. He died on the fourth day of hospitalization. Varicella zoster infection was confirmed by real-time polymerase chain reaction (PCR), a method based on fluorescence resonance energy transfer (FRET).
