Exuberant Varicella-Zoster Exanthema and Pneumonia as Clinical Clue forHIV Infection
Filipa Mestre A. Dias,Filipa Marçal,Joana Oliveira, Marta Póvoas, Ana Mouzinho, José Gonçalo Marques
DOI:
http://dx.doi.org/10.1016/j.jpeds.2014.09.047 Abstract
A 4-year-old boy presented to the hospital in the sixth day of ongoing varicella infection with high fever, respiratory distress, and hypoxemia. Physical examination showed tachypnea, a generalized vesicular exanthema, perioral impetigo (Figure1), bilateral rales, and diminished breath sounds at pulmonary auscultation. Chest radiograph revealed bilateral, multifocal, heterogeneous alveolar opacities with nodular pattern, reaching the periphery (Figure2; available atwww.jpeds.com). Blood testing showed 9.7× 109/L white blood cells, 3.7 × 109/L neutrophils, 5.1× 109/L lymphocytes with 7% reactive lymphocytes, C-reactive protein 1.8 mg/dL, and serum lactate dehydrogenase 1335U/L.
