Varicella pneumonia complicated by acute respiratory distress syndrome in an adult

Primary varicella infection is uncommon in adults, but carries a higher rat e of morbidity and mortality than in children. Pneumonia is the most common complication of primary varicella infection in adults. However, varicella pneumonia complicated with acute respiratory distress syndrome (ARDS) is ve ry rare. We report a case of ARDS secondary to varicella pneumonia in a 26- year-old man with primary varicella. The patient was otherwise healthy and had no evidence of human immunodeficiency virus infection. The initial ches t radiograph showed bilateral reticulonodular infiltrates, which quickly ev olved to diffuse alveolar consolidations. Arterial blood gas analysis revea led a ratio of arterial partial pressure to fraction of inspired oxygen of 87. Abnormal liver function and thrombocytopenia were also noted. Treatment consisted of mechanical ventilatory support and intravenous administration of acyclovir. His pulmonary condition gradually improved and he was succes sfully weaned from the ventilator 1 week later. He was discharged on the 15 th hospital day with a favorable outcome. His pulmonary function improved p rogressively, with normal spirometry and lung volumes, but persistent mild impairment of diffusing capacity, 6 months after discharge.